A recent study by pro-choice authors ended up showing the effectiveness of pregnancy help organizations (PHOs - but they stubbornly continue to refer to as Crisis Pregnancy Centers or CPCs).
The researchers received their data from a two-part online survey of women searching for abortion services; the first survey was the baseline, taken as the women were seeking abortion services online, and there was a 4-week follow-up from baseline. Complete methods are detailed here, in an earlier publication. The results were stratified by state, so the most populous states were not weighing down the data just by having the most respondents. After almost a year of gathering data, they had a final sample size of 857 total women from all 50 states.
The findings
PHOs see a wide variety of women, including both those very unsure and very sure about choosing abortion. Women who scored high on the Decision Conflict Scale regarding their abortion were 47% more likely to visit a PHO than women who scored low on the conflict scale, even though a larger number of women who visited a PHO overall scored low on the conflict scale.
Women who had insurance through the state or no insurance were 44% and 81% more likely to visit a PHO, respectively.
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Interestingly, women who were at all religious were only slightly more likely (12%) to visit a CPC than women who were not at all religious!
Perhaps the biggest takeaway, and the result most discussed in the study, is that women who visited a PHO were anywhere from 56% to 164% more likely to still be pregnant at the 4-week follow-up, depending on the model used for data analysis.
Additionally, of those women still pregnant after visiting a PHO, they were always more likely to be planning to continue pregnancy rather than still planning/seeking an abortion.
So. PHOs work to serve women with services they want or need and save lives in the process. How do they do it?
Tweet This: PHOs work to serve women with services they want or need and save lives in the process.
Pro-choice interpretation:
The authors speculate several reasons why women may be more likely to plan to parent after visiting a PHO:
● The PHOs offer “Material resources and emotional support” to women.
● Women may go to a PHO as a last resort because “abortion is no longer a realistic option for them due to costs constraints and lack of geographic access.”
● Women may have been misled into believing the PHO offered abortion and “may have sought out abortion care or referrals from CPCs, and not being linked to abortion care, may see continuing their pregnancy as the only option.”
● The PHO lied to them to get them to not choose abortion by giving them “inaccurate information on abortion and breast cancer, infertility, and mental health problems” and convincing women that “abortion is a greater health risk than continuing a pregnancy.”
● The PHO shamed them into not choosing abortion by reinforcing “abortion stigma.”
One of the authors is affiliated with the pro-choice organization Advancing New Standards in Reproductive Health (ANSIRH). ANSIRH framed the findings as yet another strike against PHOs:
“Research shows that pregnant people need access to unbiased info and resources so that they don't have to visit crisis pregnancy centers (CPCs), which operate with the goal of convincing those who are considering an abortion not to get one.”
Pro-life interpretation:
While the framing of the results attempts to project a death knell for PHOs, the results themselves are actually quite encouraging for the pro-life movement.
The fact that women who have no or only state health care coverage are more likely to visit a PHO is a pretty good indicator that PHOs are providing desired services to women who have limited ability to pay for services.
This study also further confirms that women do seek and visit PHOs when they seek an abortion; the fact women walk away less likely to get an abortion also tells us that PHOs probably help address the root causes that women seek an abortion.
As Alexandria DeSanctis at National Review stated,
“Once again, it seems impossible for ‘pro-choice’ activists to comprehend that, in the majority of cases, women don’t actually want to choose abortion — and that, far from harming or misleading these women, the majority of CPCs actually offer women a real choice by giving them the help they need to choose life.”
Nafisa Kennedy, Director of Heartbeat International’s 24/7 contact center Option Line, commented after reading the study, “I have a feeling those in the pregnancy help movement would see the data alone (without the commentary) as validation of the life-saving [sic] work we do, and an exhortation to keep going.”
Common ground
Before critiquing the article or the authors, let’s first focus on the common ground pro-life people can have with these pro-choice authors.
First, as stated in the ANSIRH article and on study co-author Alice Cartwright’s Twitter thread associated with it, it is apparent that pregnant women need help during pregnancy. Women need access to caring, low-cost or free pregnancy services, and women deserve accurate information about pregnancy and all their options.
Sara Littlefield, Heartbeat International Ministry Services Specialist, even said,
“I feel like we can even agree with their conclusion while tweaking it a bit: ‘Pregnant people need access to accurate information, decision support, and resources to make the pregnancy or abortion decision that is best for them.’”
In fact, PHOs are committed to providing true information to clients and take their commitment to honesty in communication very seriously.
Limitations
There are many limitations of this study, some of which are freely admitted by the authors and some of which are completely ignored by the authors.
To start with, the authors admit the sample of 857 women they collected data from is “not nationally representative of all individuals considering abortion,” because the loss to follow up weighed the sample toward older, white, more educated respondents and to people with internet access. Therefore, the respondents could be weighted toward urban or suburban women and/or to higher-income women.
Additionally, the authors admit to not asking about the actual experience the woman had at the PHO.
Did they feel the PHO directly affected their pregnancy decision? Did they receive the services they wanted? Did they feel lied to or deceived? Did they know the PHO was not an abortion provider before visiting?
Not asking about the actual experience at the PHO limits the study authors’ ability to enumerate the reasons why women who visited PHOs were more likely to still be pregnant and planning to parent after visiting one. However, it seems to free up their ability to wildly speculate with no data to back up their assertions, like they do many times throughout the article.
Additionally, they asked women who continued pregnancy if wished they’d had an abortion; but did not ask women who’d had an abortion if they wished they had continued their pregnancy.
As Lyman Stone, a demographer, stated about those missing pieces of information and framing of the questions:
“They speculatively consider what services CPCs might provide and what lies they might tell, but didn't actually ask women about their experiences at CPCs...Lots of decisions like that where it looks like a fishing expedition.”
The authors do not share important data they did collect, such as:
● what factors made it easier/harder to get an abortion
● how easy or difficult it was to decide whether to have an abortion
● whether they had attempted to self-manage their abortion
● financial costs associated with the abortion
● The abortion stigma scale scores
Since the data is not available publicly in a data repository, even as de-identified responses, the raw data and the results of the various statistical models cannot be confirmed by other scientists and researchers. One must make a request in writing for the de-identified data and must obtain the necessary ethical approvals to get that data — but we’re not even told what those necessary ethical approvals are or who can make such requests.
Critiques
There are two major critiques I have of the study.
One is that the authors hypocritically rail on PHOs for providing “false information” while using debunked claims and ignoring a substantial amount of data, which lowers the authors’ credibility.
For example, the authors promote the debunked myth that “abortion is 14x safer than childbirth” to claim that PHOs must be lying to women about the health risks of abortion.
Political scientist and professor Michael J. New points out that the authors, “claim, with no evidence, that pregnancy-help centers provide ‘inaccurate information’ about the risks of abortion.”
Well, technically they do provide evidence. It’s just not very good.
They cite a study done in North Carolina where the authors were upset that centers discussed risks of abortion the researchers claim are false:
“Inaccurate information provided included a link between abortion and breast cancer (16%), infertility (26%) and mental health problems (26%).”
However, correlations between abortion and all of those conditions or events have been established through a wealth of published literature. (See here, here, here, to start.)
Correlation does not necessarily mean causation, but such correlations should nonetheless be honestly disclosed in the interest of informed consent to women seeking any “medical” procedure, right? Even one of the study’s authors admitted they needed more information to determine if PHO’s are actually lying to women.
The assumption is that the information provided would have to be medically inaccurate to convince women to not abort — women seeking abortion would certainly never change their mind if given medically accurate information and resources to comprehensive pregnancy care!
My second and biggest critique of the paper overall is that the authors are so blatantly biased against PHOs and in favor of abortion.
They start with the assumption that abortion is healthcare and the preferable, right option and work from there.
For example, the authors state,
“Analyses of CPC websites have found that many advertise the availability of basic medical services on their sites, including pregnancy tests and ultrasounds, and also make reference to “pregnancy options” and abortion, even though they do not provide abortion care.”
Notice the authors are not saying that the PHOs are lying about offering medical services or about talking about all pregnancy options.
The authors are just mad PHOs don’t perform or refer for abortion. Why? Is there something better about abortion than parenting? Wouldn’t pro-choice people be happy that women seem to be getting the help they need? Also, many centers do provide after-abortion support, which should be considered a part of “abortion care,” right?
As Nafisa Kennedy pointed out, “50% of those who did not visit a ‘CPC’ had an abortion, likely without getting info about their options or having had the opportunity to voice their own worries/concerns about becoming a parent.”
Sidewalk counselors often note that women who aren’t even considering abortion come out of an abortion provider significantly more distressed about their pregnancy and more likely to be considering abortion.
Sara Littlefield aptly recognized of the study authors that: “they were quick to point out our locations associated with minority communities - I wonder if anyone else is targeting those communities.”
The authors seem upset that PHOs provide free services in minority communities, yet abortion providers such as Planned Parenthood also specifically target minority communities. Why is one type of service okay but not the other?
The bias is clear.
And what, exactly, do abortion providers offer women with unplanned pregnancies? A band-aid solution which kills a human and doesn’t address any of the woman’s actual needs.
We know women seek abortion for a wide variety of reasons. Helping a woman with the root cause for why she is seeking an abortion seems infinitely better than giving a woman an abortion and not addressing her underlying needs. PHOs around the world are happy to help pregnant women with what they actually need.
Tweet This: Pregnancy help organizations around the world are happy to help pregnant women with what they actually need.
Editor's note: Heartbeat International manages Pregnancy Help News. This article has been updated.
