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Crisis pregnancy centers are using the language and technology of modern medicine to help soften their appeal to clients--but not their anti-abortion aims.

Medicine or ministry? 

Crisis pregnancy centers are using the language and technology of modern medicine to help soften their appeal to clients--but not their anti-abortion aims.

Twice a week, Georgina Fierro Keene pulls on a white lab coat and heads to the clinic she manages at Pregnancy Support Services in Durham. The organization is not a medical outfit and Fierro Keene is not a doctor, though she does have medical training.

Pregnancy Support Services is a Christian ministry that runs local counseling centers for women facing unplanned pregnancies. The centers in Durham and Chapel Hill advertise under "Abortion Alternatives" in the phone book. They offer free services such as pregnancy tests, parenting classes, baby clothes and equipment, and information on adoption. What they don't do is perform abortions or make referrals to abortion clinics (though they do offer post-abortion counseling for women who want to talk about past abortions).

Two years ago, the group's leaders decided to try something new. With funds from an anonymous donor, they purchased an ultrasound machine and hired Fierro Keene as clinic manager to run it. Ultrasounds are done at the Durham office in Westgate Plaza, in a room just big enough for a desk, a white-paper-covered exam table and a blue-and-white imaging machine. On one wall hangs a "Seeing Without Sound" poster that illustrates how a fetus develops in the womb. On another are Fierro Keene's framed credentials from Duke University, where she trained as a physician assistant. (She has an undergraduate degree in human biology from Stanford.)

At Pregnancy Support Services, ultrasounds are offered free to women who've been through an initial counseling session. They are only done in the first trimester and provide only limited information, such as confirming the existence of a pregnancy and calculating the gestational age of the fetus.

But as Fierro Keene has discovered in the exam room, that information can be a powerful influence on the women who come to the center for help. She says after seeing the flash of a fetal heartbeat, some women vow to give up smoking or other bad habits. They often express surprise about how quickly a baby develops. Sometimes, they bring family members or boyfriends with them to watch the intimate images onscreen.

The ultrasounds aren't really a health-care service, since women aren't coming in for diagnostic assistance or expert care. But that's how Fierro Keene views them. She keeps charts that are reviewed by a doctor who volunteers as the center's medical advisor.

"This is objective information the women should have. It's not a coercive tool," she says, without even being asked the question. "Especially if they are abortion minded, I always ask if they want to see the screen or not." She says she's never had anyone refuse.

For years, people have argued about the work of crisis pregnancy centers, which have been around since before Roe v. Wade. In the late 1980s and early 1990s, complaints about graphic videos, religious harangues, false medical information and misleading advertising led to investigations and, in some states, lawsuits against centers and their staff. (See "On the Record," p. 22)

Now, a growing number of pregnancy support centers--many of which are affiliated with conservative Christian networks--are rejecting old-style scare tactics in favor of new forms of persuasion that rely on the dispassionate language and technology of modern medicine. More centers are buying ultrasound machines, hiring medically trained staff, providing counseling on sexually transmitted diseases and taking other steps toward what one national leader calls a "medical model" of service.

The changes have helped some centers reach more women. The Pregnancy Life Care Center in North Raleigh, for example, has seen the number of annual office visits rise from 1,100 to more than 1,700 in the year since it started giving free ultrasounds.

But they haven't resolved the broader debate over the centers' anti-abortion aims. Are pregnancy centers, as their leaders portray them, valuable community service organizations providing women with support and information they can't get elsewhere? Or are they, as abortion-rights activists describe them, "fake clinics" that lure women in with free medical services, then use one-sided information to dissuade them from having abortions?

The answers are hard to pin down outside the privacy of center counseling rooms. But there is troubling evidence from some quarters.

The National Abortion Federation, which represents abortion providers, has been collecting stories from women who say they've been intimidated or misled by crisis center volunteers. The accounts describe dubious scientific studies, delays in giving test results in order to keep women at counseling sessions, unmet promises of material help and graphic images of aborted fetuses as among the strategies employed by center volunteers.

Local pregnancy center leaders deny using deception, upsetting images, or any pressure tactics with clients. They say their purpose is helping women, regardless of whether they ultimately choose abortion, by giving information and support that promotes alternatives.

"What we are going to explore is what it is in her environment that's making abortion attractive," says Mimi Every, a petite dynamo who's been executive director of Pregnancy Support Services (PSS) for half of its 20-year history. "We're certainly not making decisions for her. We don't refer for abortion, but for clients who are abortion minded we are prepared to share information about the risks. By law, abortion providers don't have to talk about risks. Where's the choice in that?"

Member guidelines for Care Net, a Christian network of 700 crisis pregnancy centers in the United States and Canada that includes PSS, specifically denounce "any form of deception in its corporate advertising or individual conversations with its clients."

But critics say even when outright deception doesn't occur, center volunteers still use selective information to steer women away from abortion.

"Their tactics have become more subtle," says Paige Johnson, a spokeswoman for Chapel-Hill based Planned Parenthood of Central North Carolina. "They may not use graphic videos, but they do talk about post abortion syndrome--something that only exists in their minds." (The syndrome is a term coined by abortion foes to describe a host of psychological distress symptoms they say are caused by abortions. But it's not recognized by any scientific or medical authority.)

Medical terminology and medical services give pregnancy centers an air of professionalism that inspires the trust of women who come through their doors. The entrance to the Pregnancy Life Care Center in North Raleigh looks exactly like a doctor's office, with its magazine racks and receptionist behind a glass partition.

The new services have also allowed centers to soften their approach with individual clients. Ultrasound images may pack an emotional punch, but they aren't confrontational in the way that pictures of aborted fetuses are. Says Andrea Hall, executive director of the Pregnancy Life Care Center, "We don't believe in graphic pictures or videos. The facts speak for themselves."

But facts are a problem when it comes to some of the medical information disseminated by pregnancy center volunteers. Many centers are still handing out flyers that link abortion and breast cancer--a link that's been discredited by national scientific panels. Care Net's manual for volunteers acknowledges that studies have been "inconsistent," but says, "our role is clearly to include this possible risk when we educate clients about all the risks of abortions."

It's not just information that pregnancy centers offer that's sparked criticism; it's what they leave out. For example, center volunteers are trained to stress the risks of abortion, but not that it's statistically 11 times safer than childbirth. Pregnancy Support Services uses a pamphlet called "Abortion: Some Medical Facts" that describes abortion procedures performed in the third trimester (including the controversial "partial birth" method) but doesn't mention that in North Carolina, abortion is only legal through 20 weeks.

And there are other examples of how the rhetoric of pregnancy support work is sometimes on a collision course with medical reality. Volunteers talk about sexually transmitted diseases, but don't dispense condoms that protect against the worst of them. When asked why they don't give clients--most of whom are young and sexually active--information about birth control, local center leaders do a complex sidestep.

"There are so many things we know now that condoms don't protect against," says Hall. "So we'd be presenting an option to our clients that could potentially expose them to STDs."

"We don't want to dilute our [abstinence] message," says Jenny Dixon of Care Net, which is setting up its first national medical advisory board. "We're aware that our clients know where they can get contraceptives. Because it's made so available by other organizations, it's not an issue for us."

She adds that crisis pregnancy centers, despite the new medical trend, have never claimed to be full-service clinics. "It's health care versus health-care ministry," Dixon says.

On a balmy night in April, the banquet room at the Sheraton Imperial in Research Triangle Park is filling up for the annual "Celebration of Life" fundraiser for Pregnancy Support Services. Red balloons create a splashy entryway and red geraniums stand out on cloth-covered tables. At the front of the room, pictures of infants and toddlers--children of center clients--flash across a large screen. A line from scripture illustrates the larger-than-life family album: "Whoever Welcomes a Little Child Like This in My Name Welcomes Me."

It was at a similar banquet two years ago that center leaders made a plea for funds for an ultrasound machine. "We prayed about it and decided we wanted to go that way," says Karlene Scott-Turrentine, a Raleigh lawyer who chairs PSS's board. "Statistics show that 95 percent of women who see their babies through an ultrasound choose not to abort." The pitch worked: Turrentine says an anonymous donor wrote out a check right there to cover not only the approximately $28,000 cost of the machine, but money for trained staff to run it.

At this year's banquet, ultrasounds are mentioned along with other services PSS has added in the past few years, including abstinence training for youth, programs for expectant fathers and outreach to Latino communities. This time, the primary pitch is for funds for more staff to do abstinence workshops in area middle and high schools.

The language from the podium is mostly that of professional, nonprofit work. But when keynote speaker Ryan Dobson arrives, the ministry side takes over.

Dobson--who's dad is James Dobson, founder of the conservative Christian group Focus on the Family--puts the work of crisis pregnancy centers squarely on the front lines of the war against legalized abortion. Early on in his speech, he equates protecting the unborn to "what we're doing in Iraq--protecting people who can't protect themselves."

Dobson lauds center volunteers for fighting a tough battle. "It's emotionally tiring when you've counseled a young girl for weeks and then she walks out and you know she's going to murder someone," he says. "But for every life you save, a cheer goes up in heaven: 'Well done, my good and faithful servant.'"

Medical services are being added as crisis pregnancy centers are poised to become more influential than at any point in the country's three-decade-old tug of war over legal abortions.

For one thing, the number of such centers, estimated at anywhere from 2,500 to 4,000 nationwide, now vastly exceeds the number of abortion providers. In North Carolina, for example, there are at least 72 crisis pregnancy centers scattered across the state, says a list at www.pregnancycenters.org--including five in the Triangle. By contrast, there are only 17 licensed abortion providers statewide. And they operate in only 20 of North Carolina's 100 counties, including Orange and Wake.

Those numbers are cause for concern among abortion-rights advocates. "By sheer volume, they [crisis pregnancy centers] may be reaching more women," says Paige Johnson, of Planned Parenthood, which is one of the state's few licensed abortion providers. "The issue is the proliferation of these centers that dwarf organizations that provide more comprehensive services."

Such worries have grown sharper as federal and state legislators have moved to funnel public money to private, nonprofit pregnancy centers. Suggestions have varied from a bill introduced in Congress last year that would have allocated $3 million to centers to purchase ultrasound equipment, to a more ambitious effort in 1999 that would have sent $85 million to states to set up new "alternatives-to-abortion services." (The key sponsor was Republican Sen. Rick Santorum of Pennsylvania, who's made headlines recently with disparaging comments about gay sex.)

Existing funding strategies include such programs as Virginia's sales-tax exemption on equipment purchased by crisis pregnancy centers, and federal grants for abstinence-only sex education that were part of the federal 1996 welfare reform law. It's estimated that $3 million of $20 million doled out by a federal maternal and child health program launched in 2000 has gone directly to crisis pregnancy centers.

The most popular avenue for new money is reported to be the "Choose Life" license plate program. Under laws passed in three states and being considered in several others, proceeds from the $20 to $70 fees charged for such plates support the work of pregnancy centers. The rules specifically prohibit money from going to centers that refer for abortions or charge clients for services, as Planned Parenthood does.

Florida, Louisiana and South Carolina have all passed "Choose Life" license plate laws (though a lawsuit is pending against South Carolina's) and North Carolina is trying to follow suit. A bill introduced this session by state Rep. Mitch Gillespie (R-Caldwell) would use license plate proceeds to create a statewide Crisis Pregnancy Fund for centers that help women who "are committed to either raising their own children or placing their children for adoption." Again, centers that do abortions or make referrals to providers are not eligible for funding. (To read the bill, go to www.ncga.state.nc.us and click on "House" and then "Gillespie").

That's not to say that all crisis pregnancy centers are jumping at the chance to land a government grant--even though many are small and struggling. Many center leaders see too many strings attached to public money, including rules that might restrict religious messages. Except for the abstinence-only education grants, none of the local pregnancy support center leaders interviewed for this story expressed interest in public dollars.

"We're 100 percent privately funded and we don't have any intentions of taking government money," says Hall, of the Pregnancy Life Care Center in Raleigh, which runs on an annual budget of about $350,000. "Our center is doing really well. We have a loyal base of donors and that continues to grow."

Still, raising their profile is a priority for many centers--one the medical model can help them achieve. PSS Board Chair Scott-Turrentine wishes more public agencies would see pregnancy support centers as a resource. "We have business people supporting us and yet we're still fighting the health departments for clients," she says. "Why couldn't the state encourage people to come to us for pregnancy tests?"

Sentiments like those have abortion-rights advocates worried that crisis pregnancy centers, with their mainly volunteer staffs and limited medical services, are positioning themselves to compete for funds with organizations that offer all options to women--including abortion.

"If you are going to be provided with public funding you need to meet certain standards which they [crisis pregnancy centers] do not," says Vicki Saporta, president and CEO of the National Abortion Federation, whose members are regulated by state laws. "With crisis pregnancy centers, you're not dealing with medical personnel. You're dealing with individuals who have an extreme anti-choice agenda in many cases. They do not discuss pregnancy options in a fair and objective manner."

It's no surprise to donors and volunteers that crisis pregnancy centers have an agenda. But are those aims made clear to the women who come to them for help? And how does the medical model, which is built around objective health-care services, square with the centers' hopes to steer women away from abortion?

To verify the claims of local center leaders that their missions are made explicit to clients, The Independent made anonymous phone calls to two long-established centers--PSS and Pregnancy Life Care. Both centers advertise under "Abortion Alternatives" in the phone book, as well as in local college and high school newspapers.

The caller was a woman in her early 20s who said she'd had a positive pregnancy test and was unsure about what to do. The PSS volunteer didn't mention free ultrasounds. When asked if the center made referrals for abortions, the center representative offered to send the caller some written information or set up an appointment to talk to a counselor about "the pregnancy process." The volunteer also described a system whereby women who come in for counseling sessions can accumulate "points" that are used for free baby clothes and equipment.

The Pregnancy Life Care volunteer did describe free ultrasounds in the initial phone call, as well as post-abortion counseling. When the caller said she wasn't sure if she wanted to have a baby, the volunteer asked if she'd had an abortion before. "We need to get you set up for an ultrasound," the center volunteer said. "It sounds like you need to talk to one of our counselors."

Besides drawing women to the center, the ultrasound offers an opening for talking about their options. At PSS, the exam takes about 10 to 15 minutes, but women are scheduled for twice that long to allow plenty of time for counseling. Abortion is often discussed, Georgina Fierro Keene says. But she insists there's no pressure or judgment involved.

"To me, abortion is an issue of the heart," she says. "Sometimes I bargain for time. I tell them, 'Try to live with a decision to abort today. Tomorrow, try to imagine carrying it to term.'"

Still, while Fierro Keene has never had anyone at PSS change their mind about having an abortion after having an ultrasound, it has happened at the OB-GYN clinic where she also works. "I have had women reflect and say things like, 'I had no idea that the fetus was moving and had a heartbeat,'" she says, "It is an influence."

She quickly re-emphasizes that she views the ultrasound as a health-care service, not a tool for proselytizing. During exams, she routinely hands out information on nutrition and the need for prenatal care, and she says she doesn't discuss fetal development unless asked.

But others are clearly interested in the persuasive power of the images. Betty Rogosich of the Birthchoice center in Raleigh, remembers a woman who was considering having an abortion at 12 weeks. "I thought, oh, if only she could see what this baby looks like," says Rogosich, whose position as center director is a volunteer one. "Deep down, she didn't want that abortion."

Birthchoice, which has a roster of about 25 to 30 clients each month, doesn't have an ultrasound machine. So Rogosich got on the phone to an OB-GYN practice she knew of and offered to pay for an ultrasound for the woman. Rogosich says the practice--which she declined to name--agreed to waive the fee and has continued to do free ultrasounds for Birthchoice clients.

If pregnancy centers were focused only on providing services to women who want to continue their pregnancies, abortion-rights advocates say, their tactics wouldn't be in dispute. "There's a valid need for those services," says Johnson, of Planned Parenthood. "That's an honorable thing to be doing."

What's at issue, she says, is how carefully pregnancy centers tread the intricate territory of decision-making for women facing unplanned pregnancies--an issue that's complicated when services assume the impartial, authoritative trappings of modern health care.

Pregnancy center supporters counter that questions of fairness could just as easily be aimed at the other side: How often do abortion clinics and Planned Parenthoods encourage women to consider alternatives to abortion? How often do they help women deal with negative feelings about past abortions or inform them of risks?

Kristen Singh, who does "options counseling" at the local Planned Parenthood, believes those are questions abortion-rights advocates should be asking themselves more often.

"I think Planned Parenthood really succeeds in being nonjudgmental," she says. "When we do options counseling, we tell women they basically have three choices: parenting, adoption and abortion."

Yet the organization is still perceived as pushing abortion. "I know women who've been apologetic when they say, 'I'm not ready to do this' and they're surprised when we say, 'OK,'" Singh says. "I guess we're not getting that message out clearly enough that we're helping women make decisions that are best for them."

When it comes to a subject as charged as abortion, can anyone really be objective in counseling women?

Probably not, says Kathleen Joyce, an assistant professor of religion at Duke who studies medicine and is writing a book about the history of therapeutic abortions. "Abortion is so polarized," she says. "It's not as though one side is completely clean and the other isn't."

What troubles Joyce about the idea of crisis pregnancy centers providing medical services is that, unlike health clinics, they are unregulated, and because their services are free, they are more likely to draw from needy, low-income populations.

Pregnancy center leaders say free services are a sign of their commitment to helping women. "Money is not an incentive for us," says Hall. "The fact that we offer our services free shows a lack of agenda."

But Joyce disagrees. "That just makes it more coercive," she says. "They are preying on people who are vulnerable."

Even some pregnancy center supporters admit that when it comes to working with clients, there are fine lines to walk--lines the medical model hasn't erased. "There is a huge debate in the crisis pregnancy center movement about what is the right degree of zealousness," says John Thorp Jr., a professor of maternal and fetal medicine at UNC-Chapel Hill, who's been a longtime supporter and advisor to PSS. "I think pregnancy centers struggle with that as well as if not better than Planned Parenthood struggles with that."

Clearly, pregnancy centers have a stake in the abortion issue. But Thorp--whose wife is a former PSS board member and whose father helped found a crisis pregnancy center in Rocky Mount--believes most have evolved to the point where they reject in-your-face-style advocacy that pits the mother against the fetus.

"Whatever you think about the intrauterine occupant," he says, "you quickly realize that the container is an independent moral agent and you won't get very far being mean or ugly or directive."

But even if the approach is respectful, is it right to use free medical services to recruit clients for what is, at heart, a non-medical mission? As Joyce says, "This isn't disinterested benevolence, although they are trying to enclose themselves in the cloak of benevolence. Some agendas are more transparent than others."

The number of pregnancy centers offering medical services is still quite small. The conservative advocacy group, Focus on the Family, estimates that only about 100 centers nationwide now own their own ultrasound machines. Still, interest in offering services such as testing for sexually transmitted diseases, ultrasounds--even prenatal care--is clearly growing, as are efforts by elected officials to secure new funding.

It's those efforts that threaten the peaceful coexistence that both sides say pregnancy centers and groups like Planned Parenthood have enjoyed for decades in the Triangle. "I don't discount the work that they do for women who know they want to keep their babies," says Johnson, whose organization has vowed to fight the "Choose Life" license plate bill. "But I don't think that government money should go to organizations that don't provide a full range of services."

Awareness of controversy may be one reason why some center supporters want to distance their service work from the broader anti-abortion cause.

David Walmer is a infertility specialist at Duke University Medical Center and an advisor to PSS. Initially, he was comfortable talking about the center's work, but he became far less so when he learned he would not be able to see a copy of this story before publication. "What this organization is doing has nothing to do with that [abortion] issue," Walmer said, in explaining his concerns about being quoted. "And it does a great disservice to the ministry to say that it does. The mission is to support women who are pregnant and need services."

But that's not the approach favored in a 1998 market research report the national Family Research Council prepared for crisis pregnancy centers. Noting that the crisis pregnancy center movement is in a "period of transition," the report warns against focusing on services at the expense of efforts to reach women "at risk" for abortion.

"Widespread anecdotal reports suggest that there are sharply rising numbers of women coming to centers who are not 'at risk' for abortion," the report states. "These women have decided to carry their children and come for material assistance or other services. ... The challenge all centers share is to increase the numbers of 'at risk' women coming into their centers for help."

At Planned Parenthood's clinic in Orange County, a series of spiral-bound notebooks offers clients the opportunity to write unsigned comments about their experiences there. Although abortions make up the smallest proportion of services offered (93 percent of services are preventive, such as annual gynecological exams), almost all of the entries are from women who came in for abortions.

The writing is intimate, often heartbreaking.

"The choice wasn't hard, but I know the consequences will be," writes a 17-year-old mother of one who was about to graduate high school. "But only God knows my heart."

"I prayed and prayed before coming," another woman writes. "I have a new vision of life and your right to choose."

"I hope God will forgive me," a later entry reads. "I hope I live long for the sake of my other three children."

These are the women that crisis pregnancy centers hope to reach--the women who are "at risk" for abortion. And as the marketing plan makes clear, scare tactics won't work in attracting them.

"Our findings indicate that American women want to maintain their sense of control and independence, even when they find themselves unexpectedly pregnant," the report states. "They do not want to be viewed as if they are in 'crisis,' nor do they want to be pitied or patronized. Rather, they want to be empowered to carry their children to term. Centers that affirm this value in their names, services, and approach to women will have far greater appeal."

The medical model helps move pregnancy centers from what the report calls a "defensive, low public profile" to a much more confident one by avoiding political debates and focusing instead on health-care and psychology. At the same time, the aura of medical expertise gives their anti-abortion message more weight.

Mimi Every of PSS displays some of that confidence when she's asked whether her primary aim is to help women facing unplanned pregnancies or reach women who are contemplating abortion, "It's both," she replies firmly.

She's not fazed by critics who say the latter goal is what inspires her work. "We're here to provide support for women. Politics isn't going to drive us," Every says. "We're here in a one-on-one situation, a quiet place where women can express their concerns. I don't think centers like ours are going to go away anytime soon." EndBlock

Prodigal Daughter
Sarah Brubaker is a 23-year-old former client and current volunteer at the Pregnancy Life Care Center in North Raleigh who's studying to be a physical therapist. She's spoken at the center's annual fundraiser and at area high schools about her experiences with an unplanned pregnancy two years ago. Here are excerpts from an interview with Brubaker. Although she was happy to talk about her contacts with the center, she asked that the details of her pregnancy and subsequent adoption of her baby not be discussed.

"I came here a few months after I found out I was pregnant. My mother and father had friends who'd volunteered here. At that time, I was rebellious. I came here to please my parents. It was very hard to tell them I was pregnant. But they are very loving. When I first came here I was very uptight. We watched a video and talked about my plans, which were to parent.

What helped me the most was they were loving and accepting with an open ear. They gave me all the options. More like an objective third party for me. It was good to come and vent. My parents came and met with somebody before I came. When I was six or seven months pregnant, my brothers came here, too. I moved to Florida when I was seven and a half months pregnant and placed for adoption down there.

Abortion was never an issue for me. I didn't come here for information on that. What I needed was just somewhere I could go and for someone to really listen to me and help me with what as going on in my head. When I first came I was planning on parenting so I wanted items for the baby. My plan at the time was to stay home and raise the baby. I wanted someone to reassure me, give me hope that this wasn't the end of the world. I'd always wanted to be a mother.

I just learned that parenting isn't heaven, it isn't easy. It opened my eyes a bit. I learned that adoption is a positive thing, a very loving choice where you are looking out for the best interests of the child. At the center, I'd gone through an adoption workbook. I just never thought about it up until that point. I had the typical response that I could never carry my child for nine months and then have someone else raise it. But about a month later, it hit me and I knew what's what I wanted.

I found a very strong, Christian family with the same morals and beliefs that I had come back to. I get pictures and letters through the adoption agency. The old cliche about it being bittersweet is true. In my heart, I know I was doing what God wanted me to do and that I was looking out for her.

The separation was hard and I did grieve. I met with the center client services director on a bi-weekly basis for counseling. I'm very thankful someone was here for that. I hadn't sought counsel in a very long time--Christian counsel. I found out I was not living the way I should have been living.

The advice I give [to women she counsels at the center] is there is hope and there is time not to rush off and make a hasty decision regarding abortion or parenting or adopting. Coming here will help them sort through the voices of their peers, family members, their own voice.

It is different sitting on that side of the couch. It's very rewarding to know I'm touching other girls' lives. I show them this isn't the end of the world. I can relate to them. The girls I've encountered have been mostly in college. It's difficult when they are [considering abortion]. I hurt for them. I can give them information about what will happen to their body, the procedures, what will be the consequences, emotionally and physically. I just want to stress that I ended up getting that listening ear and the hope I needed. That's why I would encourage girls to come here."

A crisis pregnancy
The National Abortion Federation has been collecting stories from women who say they've been misled or mistreated at crisis pregnancy centers. Here is one from "Jane Doe" written in August 2001 that's posted on the NAF Web site.

"When I first found out that I was pregnant I was scared and confused, as most people are. I didn't know who to turn to. So, I looked in the phone book for a place that would answer my questions and refer me to a doctor. I saw an ad for a free clinic in a Maryland suburb. On the phone I asked if I could see a doctor. I thought from the conversation on the phone that I would get medical help at the clinic. The woman on the phone encouraged me to make an appointment that same day and I did.

I went there and as soon as I walked in the door it first hit me that I was pregnant. In the waiting room, there were pictures hanging on the wall of mothers and their babies and literature on the tables about pregnancy.

They took a urine pregnancy test, and without giving me the results took me into a room with another lady for counseling. She had mentioned to me that it was her first day volunteering for the center and that was why she would be reading from a manual that the center had prepared for her.

First, she began by telling me that life begins at conception. Then she had me hold a model baby that was about two to three inches long, and she said that would be the size of a baby in the first trimester. Then she moved on to birth control. She kept repeating after every statement it seemed, 'this is not what God intended' or 'this is just not natural.' She mentioned that one in every five condoms breaks. She also mentioned that the pill could sometimes be a form of abortion and that I could take a class on family planning to help me with my birth control needs.

She told me a lot of scary things about abortion and showed me awful pictures. I knew she was wrong about the condom breaking that much, so I thought she was probably wrong about all the things she was telling me about abortion.

I got impatient and asked for the results of my test. She went to get them and then informed me that I was indeed pregnant. It really hit me. I started crying and she gave me a hug and said that she would be there for me. She said she could understand what I am going through and kept referring to it as a 'crisis pregnancy.' She told me that 'Mary's Center' had many resources for me such as maternity clothes, baby clothes, and diapers. She started asking me about my situation in specific and about my family. I told her that my mom had died and she said, 'I know that this is what your mom would want for you.' She told me that she knew I would do the right thing. She gave me a number to call at Saint Agnes Hospital and told me to not go anywhere else.

After I left, the same woman called me about once a week or every two weeks. I guess they have their phone number blocked so it will not come up on caller ID. When I answered the phone, the woman asked me how far along in my pregnancy I was and if I had found a doctor. I felt uncomfortable because I had an abortion and didn't want her to know and my privacy was completely invaded."

On the record
Debate over the work of crisis pregnancy centers isn't new. Over the last 20 years, complaints about tactics used by center counselors have sometimes led to lawsuits. In North Carolina, the Attorney General's office has fielded no complaints and launched no investigations to date of crisis pregnancy centers. Here are some cases the National Abortion Federation has logged that have been filed against pregnancy centers by clients, state officials and abortion rights groups in other states.

State of New York
(New York, 2000)
In 2002, the state Attorney General of New York launched the first major investigation of crisis pregnancy centers since the mid-1990s, issuing subpoenas for centers suspected of deceiving women about their services and practicing medicine without a license. The investigation ended in a model agreement reached with a Birthright Center that clarified acceptable practices for pregnancy centers. They include: clearly informing clients that they don't provide abortions or birth control or make referrals for them; disclosing verbally and in writing before providing a pregnancy test that they are not a licensed medical provider and can't diagnose or confirm the pregnancy; clarifying in advertising and contacts with consumers that the pregancy tests they offer are self-administered; and telling everyone who calls or visits the center that it is not a medical facility.

Planned Parenthood of South Carolina vs. Rose
(South Carolina, 2001)
In response to a suit brought by Planned Parenthood and a local doctor, a district court ruled that the state's Choose Life license plate program, which gives proceeds from special "choose life" plates to crisis pregnancy centers, violated Constitutional provisions of free speech because there is not a comparable "pro-choice" plate offered. The court made permanent an injunction against the law that had been in place since November 2001.

Stoner v. Williams
(California, 1996)
A center client successfully sued a pregnancy center for fraud after she said she was coerced into signing adoption papers. While she was in labor, she was presented with papers and told they were hospital forms. She signed them not realizing she was giving her baby to a Tennessee couple to adopt. When she tried to get her baby back, a Tennessee court told her that her parental rights had been terminated on grounds of abandonment.

Hughes v. Abrams
(New York, 1995)
This lawsuit led to an out-of-court settlement in which a crisis pregnancy center agreed to 1) stop soliciting and collecting urine for pregnancy tests without a valid permit; 2) stop "pregnancy diagnosis"; 3) begin advertising under the heading "Abortion Alternatives"; and 4) make clear to telephone callers that it did not perform or refer for abortions.

Roe v. San Diego Pregnancy Services
(California, 1994)
A crisis pregnancy center was banned from advertising "pregnancy testing" and "pregnancy test," and prohibited from advertising that such tests were free if the kits were conditional upon anything--including receiving counseling or listening to a presentation. The center was also prohibited from performing pregnancy tests until it became licensed to do so.

Darrah v. Yolo County Superior Court
(California, 1994)
A woman lost an appeal of a case she had brought against a crisis pregnancy center that she said coerced her into giving her child up for adoption. She said after giving birth in a college dorm, pregnancy center counselors told her she had no rights, her parents would hate her and that she could not get medical care until she agreed to have the baby adopted. A trial court found she was not coerced and the woman lost on appeal.

Boes v. Deschu
(Missouri, 1989)
A patient sought damages for intentional infliction of emotional distress based on an encounter at a crisis pregnancy center. She said center employees withheld the results of her pregnancy test until after she had watched a movie showing mutilated fetuses and had listened to staff tell her that religion was the only route for women who'd had abortions. This was done, she said, even though the client did not intend to have an abortion and had suffered emotional problems following a previous abortion.

Neary v. Pennsylvania Public Utility Commission
(Pennsylvania, 1983)
The court reversed a decision of the Pennsylvania Public Utility Commission directing the telephone company to delete the listing of a crisis pregnancy center under the heading "Abortion, Birth Control and Pregnancy Testing Clinic" from the phone book. The court ruled that the telephone company had not violated regulations in listing the center that way. The court interpreted regulations as requiring the removal of ads that misled parties as to the identity of the advertiser, rather than the services provided.

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