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Kissling A, Warren E, Gursahaney P, Norris AH, Gallo MF. Crisis management: pathways to crisis pregnancy centers. Women Health 2024; 64:604-613. [PMID: 39155143 DOI: 10.1080/03630242.2024.2392140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 07/03/2024] [Accepted: 08/07/2024] [Indexed: 08/20/2024]
Abstract
Crisis pregnancy centers (CPCs) provide social support, material aid, and counseling against abortion. We evaluated the perspectives of CPC clients to understand how they found the CPC that they attended for services. In 2019, we conducted in-depth interviews with 21 clients of 10 CPCs in Ohio, who were recruited from the CPC (n = 9) or an abortion clinic (n = 12), to understand their experiences attending the center. This analysis focused on the ways in which pregnant people end up as clients at a CPC seeking assistance instead of attending another setting, such as a medical center. We identified two pathways through which clients find CPCs. First, in the internet pathway, clients needing abortion services found CPCs via internet search for pregnancy symptoms, abortion care, or ultrasound services. Second, in the social safety network pathway, clients needing material aid found CPCs through recommendations from trusted others and due to the proximity of CPCs to their homes. Structural conditions influence the pathways clients pursue, such as the need for healthcare services and material aid. Future research should further explore the demographics of those who attend CPCs and motivations for attendance.
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Affiliation(s)
| | - Evangeline Warren
- Department of Sociology, The Ohio State University, Columbus, Ohio, USA
| | - Priya Gursahaney
- Department of Obstetrics & Gynecology, University of Cincinnati, Cincinnati, Ohio, USA
| | - Alison H Norris
- Department of Epidemiology, The Ohio State University, Columbus, Ohio, USA
| | - Maria F Gallo
- Department of Epidemiology, The Ohio State University, Columbus, Ohio, USA
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2
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Reardon DC. Welcomed Pregnancies: Characteristics and Patterns of Adjusting to Unwanted, Unplanned, Untimely or Otherwise Difficult Pregnancies. Cureus 2024; 16:e61885. [PMID: 38978955 PMCID: PMC11228420 DOI: 10.7759/cureus.61885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2024] [Indexed: 07/10/2024] Open
Abstract
Background Women facing problematic pregnancies, defined as "unplanned, mistimed, unwanted, or otherwise difficult," either have abortions or make adjustments to welcome these pregnancies. These adjustments are understudied. Pregnancy resource centers that provide counseling and services to assist in the process of welcoming pregnancies have been the focus of controversy due to their refusal to counsel or refer for abortions. This survey of a national population of women seeks to quantify changes in attitudes toward problematic pregnancies that are not aborted and to gauge levels of contact with pregnancy help centers and perceptions of harm or benefits attributed to those contacts. Methodology A national research firm was enlisted to obtain 1,000 surveys completed by female residents of the United States aged 41-45, inclusive. Women reporting a history of abortion were surveyed along one path. For those who did not have abortions but reported a problematic pregnancy, questions were presented to assess changes in attitude toward their pregnancy from the date they first learned they were pregnant to 90 days later, their considerations of abortion, whether they had contact with a pregnancy help center, and their assessment of that contact on either harming or improving their lives. Results Among 275 respondents who had no history of abortion but had ultimately welcomed a problematic pregnancy, 112 (40.7%) had been at higher risk of abortion. Positive attitudes toward their pregnancies increased most rapidly for women who had been at higher risk of abortion but were lower on the day they first learned they were pregnant. Overall, 34 (12.4%) reported they had contacted a pregnancy help center that did not refer for abortions. Another 37 (13.5%) were uncertain if they had contacted an organization fitting that description. Both groups reported the contact improved their lives, on average. Negative assessments were uncommon and all were of a small degree. Conclusions Women facing problematic pregnancies who did not choose abortion experienced rapid improvements in feelings of wantedness, timeliness, acceptance, welcoming, and desirability toward the pregnancy. The rate of improvement was most rapid among those who had investigated and considered abortion. Women reporting contact with pregnancy help centers almost always assess it as having improved their lives.
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Affiliation(s)
- David C Reardon
- Research, Elliot Institute, St. Peters, USA
- Research, Charlotte Lozier Institute, Arlington, USA
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Hutchens K. "It Wasn't Very Public-Clinicy": Client Experiences at Faith-Based Pregnancy Centers. JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2023; 64:486-502. [PMID: 37222523 DOI: 10.1177/00221465231171555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Faith-based pregnancy centers strive to offer "alternatives to abortion" that supporters claim aid women and critics assert manipulate pregnant people, stigmatize abortion, and potentially delay clients from obtaining medical care. However, scholars know little about the exchanges within appointments and how clients make sense of these experiences. Drawing on ethnographic observations of client appointments in two pregnancy centers in the West and 29 in-depth interviews with clients, this article uses an intersectional framework to analyze client experiences. Clients favorably compared centers to clinical health care providers, emphasizing the unexpectedly attentive emotional care they received. These evaluations stem from clients' reproductive histories, which are shaped by gender, racism, and economic inequalities that configure their access to and interactions within the health system. Emotional care serves to create and maintain pregnancy centers' impression of legitimacy among clients.
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Kissling A, Gursahaney P, Norris AH, Bessett D, Gallo MF. Free, but at what cost? How US crisis pregnancy centres provide services. CULTURE, HEALTH & SEXUALITY 2023; 25:1024-1038. [PMID: 36063457 DOI: 10.1080/13691058.2022.2116489] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 08/18/2022] [Indexed: 06/15/2023]
Abstract
In the USA, the most popular form of anti-abortion activism, crisis pregnancy centres (CPCs), provide a variety of services to prevent abortions. Moving beyond debate about misinformation and the ethics of CPCs, this study considers the services they provide and given their popularity among state legislatures, their connection to the state. Using interviews with ten CPC staff in Ohio (a state providing support to CPCs) and supplemental data from both state and CPC organisations, we find three relevant themes. First, CPC services reflect ideas about personal responsibility and Christianity held by the CPC staff. Second, we show that CPCs have assumed a variety of state duties (e.g. pregnancy testing and parenting classes), appealing to lawmakers in conservative states eager to transfer responsibility for disadvantaged residents to other entities. Finally, we consider the future direction of CPCs, highlighting tension between organisational goals (focusing on abortion prevention) and the on-the-ground experience of CPC staff (where non-pregnant clients need material aid). Drawing theoretical connections between CPC staff and social service workers sheds light on whose responsibility it is to address poverty in a post-welfare era.
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Affiliation(s)
- Alexandra Kissling
- Department of Sociology, The Ohio State University (OSU), Columbus, OH, USA
| | - Priya Gursahaney
- Department of Obstetrics and Gynecology, University of Cincinnati (UC), Cincinnati, OH, USA
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Korotkaya Y, Chen AY, Steward R, Chan EY, Schmidt EO, Gipson JD. Evaluating the frequency of crisis pregnancy center visits among a population of patients seeking abortions in Los Angeles. Contraception 2023; 123:110024. [PMID: 36934955 DOI: 10.1016/j.contraception.2023.110024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 03/13/2023] [Accepted: 03/14/2023] [Indexed: 03/19/2023]
Abstract
OBJECTIVES Studies have illustrated crisis pregnancy centers' (CPC) disingenuous practices regarding abortion services. We evaluated the proportion of patients who visited a CPC before their abortion in Los Angeles. STUDY DESIGN Patients attending one of two abortion clinics between July 2019 and March 2020 were recruited for a survey that examined patient characteristics and locations of care. RESULTS Five hundred eleven respondents participated (62% response rate). Less than 1% of individuals visited a CPC before their abortion. Fifty-three percent of survey respondents obtained their abortion within one visit, 39% within two unique clinic visits, and eight percent visited three or more clinics. CONCLUSION CPC visits before abortion were uncommon in our patient population.
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Affiliation(s)
| | - Angela Y Chen
- University of California, Los Angeles, United States
| | - Rachel Steward
- Family Planning Associates, Women's Health, Los Angeles, CA, United States
| | - Elaine Y Chan
- University of California, Los Angeles, United States
| | - Elizabeth O Schmidt
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, United States
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Frasik C, Jordan C, McLeod C, Flink-Bochacki R. A mystery client study of crisis pregnancy center practices in New York State. Contraception 2023; 117:36-38. [PMID: 36055360 DOI: 10.1016/j.contraception.2022.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 08/22/2022] [Accepted: 08/24/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To evaluate practices of crisis pregnancy centers (CPCs) in a state with supportive abortion policies. STUDY DESIGN We called all New York State CPCs regarding their services using a "mystery client" protocol, utilizing checklists and thematic analysis. RESULTS Of 86 CPCs, 67 (78%) encouraged in-person appointments, offering free medical services and support. Twelve centers (14%) spontaneously disclosed their non-medical status, and 36 (42%) disclosed after direct questioning. Sixty-five (76%) made inaccurate or inflammatory statements about pregnancy or abortion. CONCLUSIONS In a state without specific barriers to abortion and pregnancy care, CPCs claim to provide support while using inflammatory rhetoric and concealing their organizational status.
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Affiliation(s)
| | - Claire Jordan
- Department of Obstetrics and Gynecology, Albany Medical Center, Albany, NY, United States
| | - Corinne McLeod
- Department of Obstetrics and Gynecology, Albany Medical Center, Albany, NY, United States
| | - Rachel Flink-Bochacki
- Department of Obstetrics and Gynecology, Albany Medical Center, Albany, NY, United States.
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Early pregnancy confirmation availability at crisis pregnancy centers and abortion facilities in the United States. Contraception 2023; 117:30-35. [PMID: 36084711 DOI: 10.1016/j.contraception.2022.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 08/26/2022] [Accepted: 08/29/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Crisis pregnancy centers (CPCs) seek to dissuade people from having abortions. Twenty-five states have policies supporting CPCs. We aimed: (1) to characterize access to early pregnancy confirmation at CPCs compared to abortion facilities nationwide and (2) to understand the role of state CPC policy in service access. STUDY DESIGN We conducted a national mystery caller study of 445 CPCs and geographically paired abortion facilities, posing as patients seeking pregnancy confirmation. Facility type (CPC vs abortion facility) was the primary exposure in Aim 1. Wait time to first available early pregnancy appointment was the primary outcome. In Aim 2, state-level CPC policy designation (supportive vs not supportive of CPCs) was the primary exposure. Difference in wait time ≥7 days to first available appointment between CPCs and paired abortion facilities was the primary outcome. RESULTS CPCs were more likely than abortion facilities to provide same-day appointments (68.5% vs 37.2%, p < 0.0001), and free pregnancy testing (98.0% vs 16.6%, p < 0.0001). The median wait to first available appointment at a CPC was 0 days (IQR 0,1), compared to 1 day at abortion facilities (IQR 0, 5), p < 0.0001. In states with supportive CPC policy environments, abortion facilities were less likely to have wait times exceeding their paired CPC by a week or more, compared to paired facilities in states with non-supportive CPC policy environments (p = 0.033). This remained true after adjusting for state abortion policy environment (p = 0.011). CONCLUSIONS Pregnancy confirmation is more accessible at CPCs compared to abortion facilities. Factors other than state-level CPC policies likely influence service accessibility. There is a need for improved access to pregnancy confirmation in medical settings. IMPLICATIONS Our findings demonstrating that pregnancy confirmation is more accessible at crisis pregnancy centers than at abortion facilities are predicted to be exacerbated in the wake of abortion clinic closures following the Dobbs v Jackson Women's Health Organization Supreme Court decision. This highlights the need for improved funding and support for pregnancy confirmation service delivery in medical settings, including abortion facilities.
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Ehrenreich K, Kimport K. Prenatal Care as a Gateway to Other Health Care: A Qualitative Study. Womens Health Issues 2022; 32:602-606. [DOI: 10.1016/j.whi.2022.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 06/28/2022] [Accepted: 08/16/2022] [Indexed: 12/05/2022]
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Hooberman L, Ozoguz S. Abortion, mental health and epistemologies of psychological knowledge and ignorance. SOCIAL AND PERSONALITY PSYCHOLOGY COMPASS 2022. [DOI: 10.1111/spc3.12703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Laura Hooberman
- Department of Psychology The CUNY Graduate Center New York New York USA
| | - Sedef Ozoguz
- Department of Psychology The CUNY Graduate Center New York New York USA
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Montoya MN, Judge-Golden C, Swartz JJ. The Problems with Crisis Pregnancy Centers: Reviewing the Literature and Identifying New Directions for Future Research. Int J Womens Health 2022; 14:757-763. [PMID: 35706995 PMCID: PMC9189146 DOI: 10.2147/ijwh.s288861] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 05/24/2022] [Indexed: 01/13/2023] Open
Abstract
Crisis pregnancy centers (CPCs) are nonprofit organizations that present themselves as healthcare clinics while providing counseling explicitly intended to discourage and limit access to abortion. These facilities engage in purposefully manipulative and deceptive practices that spread misinformation on sexual health and abortion. CPCs have also been shown to delay access to medically legitimate prenatal and abortion care, which negatively impacts maternal health. Along with increasing anti-abortion legislation, the proliferation of CPCs paired with the closure of abortion clinics exacerbates the ongoing harmful impact these centers have on the reproductive healthcare landscape; however, despite their growing influence, there is still limited research on patients’ understanding of and experiences with CPCs. This article provides a review of academic literature on CPCs and suggests future directions for research. Ongoing scholarship may aid in improving patient awareness and education regarding CPCs, an important step toward protecting reproductive autonomy.
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Affiliation(s)
- Melissa N Montoya
- Department of Obstetrics & Gynecology, Duke University School of Medicine, Durham, NC, USA
| | - Colleen Judge-Golden
- Department of Obstetrics & Gynecology, Duke University School of Medicine, Durham, NC, USA
| | - Jonas J Swartz
- Department of Obstetrics & Gynecology, Duke University School of Medicine, Durham, NC, USA
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Cartwright AF, Tumlinson K, Upadhyay UD. Pregnancy outcomes after exposure to crisis pregnancy centers among an abortion-seeking sample recruited online. PLoS One 2021; 16:e0255152. [PMID: 34320026 PMCID: PMC8318304 DOI: 10.1371/journal.pone.0255152] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 06/28/2021] [Indexed: 01/25/2023] Open
Abstract
INTRODUCTION More than 2,500 crisis pregnancy centers (CPCs), which seek to convince people considering abortion to continue their pregnancies, exist in the United States. However, the characteristics of people who visit CPCs and their pregnancy outcomes are largely unknown. This study sought to describe the characteristics of people considering abortion who report visiting CPCs, and whether CPC visit is associated with abortion or continuing the pregnancy 4 weeks later. METHODS Between August 2017 to May 2018, we recruited pregnant people searching for abortion services online, and 857 participants completed baseline and 4-week follow-up surveys. We described characteristics associated with visiting a CPC and compared pregnancy and abortion outcomes for those who reported CPC visit to those who did not using mixed-effects multivariable logistic regression. RESULTS Overall, 13.1% of respondents visited a confirmed CPC. Living further away from a CPC was associated with lower odds of a CPC visit. At follow-up, respondents who had visited a CPC were significantly less likely to have had an abortion (29.5%) than those who had not visited a CPC (50.5%). In the adjusted models, respondents who had visited a CPC had higher odds of being pregnant and still seeking abortion (aOR: 2.26, 95% CI: 1.37-3.73) or continuing the pregnancy (aOR: 2.35, 95% CI: 1.33-4.15) (versus having had an abortion), than those who had not visited a CPC. CONCLUSIONS CPCs may be providing resources to people who are considering continuing their pregnancy and/or they may be misleading people about the care and referrals they provide related to abortion. Pregnant people need access to accurate information, decision support, and resources to make the pregnancy or abortion decision that is best for them.
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Affiliation(s)
- Alice F. Cartwright
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Katherine Tumlinson
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Ushma D. Upadhyay
- Department of Obstetrics, Gynecology & Reproductive Sciences, Advancing New Standards in Reproductive Health, University of California, San Francisco, Oakland, CA, United States of America
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Swartz JJ, Rowe C, Truong T, Bryant AG, Morse JE, Stuart GS. Comparing Website Identification for Crisis Pregnancy Centers and Abortion Clinics. Womens Health Issues 2021; 31:432-439. [PMID: 34266709 DOI: 10.1016/j.whi.2021.06.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 05/21/2021] [Accepted: 06/03/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Crisis pregnancy centers (CPCs) seeking to dissuade women from abortion often appear in Internet searches for abortion clinics. We aimed to assess whether women can use screenshots from real websites to differentiate between CPCs and abortion clinics. METHODS We conducted a cross-sectional, nationally representative online study of English- and Spanish-speaking women aged 18-49 years in the United States. We presented participants with screenshots from five CPCs and five abortion clinic websites and asked if they thought an abortion could be obtained at that center. We scored correct answers based on clinic type. Outcomes included ability to correctly identify CPCs and abortion clinics as well as risk factors for misidentification. The survey also included five questions about common abortion myths and a validated health literacy assessment. RESULTS We contacted 2,223 women, of whom 1,057 (48%) completed the survey and 1,044 (47%) were included in the analysis. The median score for correctly identifying CPCs as facilities not performing abortion was 2 out of 5 (Q:1 0, Q:3 4). The median score for correctly identifying abortion clinics as facilities performing abortion was 5 out of 5 (Q:1 3, Q:3 5). Those less likely to endorse abortion myths had higher odds of correctly identifying CPCs (adjusted odds ratio, 2.43; 95% confidence interval, 1.78-3.32). A low health literacy score was associated with decreased odds of correct identification of CPCs (adjusted odds ratio, 0.39; 95% confidence interval, 0.25-0.59). CONCLUSIONS Websites of CPCs were more difficult for women to correctly identify than those of abortion clinics. Women with limited knowledge about abortion and low health literacy may be particularly susceptible to misidentification of CPC websites.
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Affiliation(s)
- Jonas J Swartz
- Division of Women's Community and Population Health, Department of OBGYN, Duke University Medical Center, Durham, North Carolina; Division of Family Planning, Department of OBGYN, University of North Carolina School of Medicine, Chapel Hill, North Carolina.
| | - Carly Rowe
- Division of Family Planning, Department of OBGYN, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Tracy Truong
- Department of Biostatistics & Bioinformatics, Duke University of Medical Center, Dueham, North Carolina
| | - Amy G Bryant
- Division of Family Planning, Department of OBGYN, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Jessica E Morse
- Division of Family Planning, Department of OBGYN, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Gretchen S Stuart
- Division of Family Planning, Department of OBGYN, University of North Carolina School of Medicine, Chapel Hill, North Carolina
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Rice R, Chakraborty P, Keder L, Turner AN, Gallo MF. Who attends a crisis pregnancy center in Ohio? Contraception 2021; 104:383-387. [PMID: 34038710 DOI: 10.1016/j.contraception.2021.05.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 05/13/2021] [Accepted: 05/16/2021] [Indexed: 01/27/2023]
Abstract
OBJECTIVES We sought to quantify the prevalence of ever attendance at a crisis pregnancy center (CPC) among adult, reproductive-age women in Ohio and identify demographic factors associated with ever attendance. STUDY DESIGN We analyzed data from the Ohio Survey of Women, a survey of adult, reproductive-age women (N = 2529) conducted in 2018 to 2019. We calculated unadjusted and adjusted prevalence ratios (PRs) to evaluate the possible associations between demographic factors and ever CPC attendance. Analyses used statistical weights to be population-representative. RESULTS Analyses are based on women reporting ever (n = 291) or never CPC attendance (n = 2151). Prevalence of ever CPC attendance was 13.5%. Ever CPC attendance was higher among women of Black, non-Hispanic race/ethnicity (adjusted PR, 2.1; 95% confidence interval [CI], 1.4-3.2) and currently in the lowest socioeconomic status (SES) stratum (defined as less than a college degree and annual household income less than $75,000) (aPR, 1.6; 95% CI, 1.1-2.3) compared to those of other race/ethnicity and in the highest SES stratum. CONCLUSIONS Disparities exist among adult women in Ohio regarding their ever use of CPCs. Because CPCs typically are not medical facilities and may provide inaccurate information, future studies should evaluate a wider range of correlates of recent CPC attendance. IMPLICATIONS Findings from a population-based survey of adult, reproductive-age women in Ohio indicate that ever attendance to a CPC for pregnancy-related care is not rare, and this attendance is higher among Black/non-Hispanic women and those of low SES compared to other women.
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Affiliation(s)
- Robin Rice
- College of Medicine, The Ohio State University, Columbus, OH, United States
| | - Payal Chakraborty
- College of Public Health, The Ohio State University, Columbus, OH, United States
| | - Lisa Keder
- College of Medicine, The Ohio State University, Columbus, OH, United States
| | | | - Maria F Gallo
- College of Public Health, The Ohio State University, Columbus, OH, United States.
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"Gummy Bears" and "Teddy Grahams": Ultrasounds as religious biopower in Crisis Pregnancy Centers. Soc Sci Med 2021; 277:113925. [PMID: 33878663 DOI: 10.1016/j.socscimed.2021.113925] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 04/05/2021] [Accepted: 04/08/2021] [Indexed: 11/21/2022]
Abstract
Scholars, activists, and medical professionals critique Crisis Pregnancy Centers (CPCs) for disseminating medical misinformation and deceptive counseling practices. Yet much of the scholarship examining CPC's counseling and medical practices relies upon discourse analyses or surreptitious approaches. I use observational data from client appointments in an evangelical CPC in the U.S. West and in-depth interviews with clients and staff to explore how guided ultrasounds construct the experience of pregnancy. I describe the "medical model of care" at this CPC and then analyze how the ultrasound becomes a socio-religious practice that shapes the social and physical experience of pregnancy. I argue this is a unique form of 'religious biopower' (Foucault 1990). Importantly, clients overwhelming describe these appointments as positive and point to how centers seemingly fill a void of care in the healthcare system. These findings reveal processes whereby faith-based, antiabortion organizations produce a 'digital quickening' through ostensibly neutral medical technologies of visualization, reinforce conservative discourses about fetal personhood and motherhood, and spread medical misinformation.
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Daniel S, Schulkin J, Grossman D. Abortion Referral Practices among a National Sample of Obstetrician-Gynecologists. Womens Health Issues 2020; 30:446-452. [PMID: 32962875 DOI: 10.1016/j.whi.2020.08.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 08/14/2020] [Accepted: 08/18/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Obstetrician-gynecologists (ob-gyns) play a critical role in improving access to timely abortion care. This cross-sectional study estimates the proportion of ob-gyns providing abortion referral in the prior year and identifies predictors of direct (facilitated) referral compared with indirect referral (providing contact information). METHODS In 2016-2017, we invited a national sample of 2,500 ob-gyns to complete a survey. We restricted the final sample of 1,280 respondents (52% response rate) to participants who had abortion-seeking patients in the last 12 months (n = 868, 68% of the sample). We calculated descriptive statistics by referral type and conducted logistic regression analyses to examine associations between physician and practice setting characteristics and abortion referral type (direct vs. indirect). RESULTS Eighty-eight percent of ob-gyns provided abortion referral (479 [55%] indirect referrals; 287 [33%] direct referrals). Abortion provision in the prior year (adjusted odds ratio, 2.82; 95% confidence interval, 1.80-4.42) was a significant predictor of direct referrals. Compared with ob-gyns practicing in the Northeast, ob-gyns in the South had lower odds of direct referrals (adjusted odds ratio, 0.39; 95% confidence interval, 0.24-0.62), whereas those in the West had higher odds (adjusted odds ratio, 1.91; 95% confidence interval, 1.14-3.23). Ob-gyns providing direct referrals were more likely to practice within 25 miles of an abortion facility compared with those who provided indirect referrals (25% vs. 5%, respectively; p < .001). CONCLUSIONS Although the majority of ob-gyns refer patients for abortion care, most offer indirect referrals, only providing contact information for an abortion provider. Ob-gyns should facilitate referrals as access becomes more constrained, especially in regions where abortion facilities are limited.
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Affiliation(s)
- Sara Daniel
- Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, Oakland, California.
| | - Jay Schulkin
- American College of Obstetricians and Gynecologists, Washington, District of Columbia
| | - Daniel Grossman
- Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, Oakland, California
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Polcyn C, Swiezy S, Genn L, Wickramage P, Sidiqqui N, Johnson C, Nair P, Bernard C, Miller V. Truth and Transparency in Crisis Pregnancy Centers. WOMEN'S HEALTH REPORTS 2020; 1:224-226. [PMID: 33786483 PMCID: PMC7784822 DOI: 10.1089/whr.2020.0057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 04/27/2020] [Indexed: 12/05/2022]
Abstract
The prevalence of crisis pregnancy centers (CPCs), their false claims, and the real harm they cause necessitate public education about their unethical practices. Also called “pregnancy resource centers” and “pregnancy support centers,” CPCs are nonmedical institutions designed to deceive women seeking comprehensive pregnancy care, as their volunteers are instructed to pedal misinformation about reproductive health care.
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Affiliation(s)
- Carly Polcyn
- University of Toledo-Health Science Campus, Toledo, Ohio, USA
| | - Sarah Swiezy
- Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Leah Genn
- Florida State University, Tallahassee, Florida, USA
| | | | - Neha Sidiqqui
- Carle Illinois College of Medicine, Champaign, Illinois, USA
| | - Candise Johnson
- University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Pooja Nair
- University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Caitlin Bernard
- Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Velvet Miller
- Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, Indiana, USA
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Roberts SC, Wingo E, Kimport K. A qualitative exploration of women's experiences discovering pregnancies in the emergency department. Contracept X 2020; 2:100024. [PMID: 32550539 PMCID: PMC7286152 DOI: 10.1016/j.conx.2020.100024] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 03/31/2020] [Accepted: 04/10/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES The few studies examining pregnancy testing in emergency departments (EDs) address pregnancy-related physical risks. Here, we examine experiences of people who discover pregnancies in EDs. METHODS Between 2015 and 2017, as part of a larger study, we conducted interviews with 29 women in Southern Louisiana (n = 13) and Baltimore, MD (n = 16), who reported discussing their pregnancy during an ED visit. We analyzed these interviews for content and themes. RESULTS Respondents reported diagnosis of pregnancy as a routine and straightforward component of care received in EDs. They reported receiving diagnostic studies and therapeutic interventions to rule out and treat complications of pregnancy and care for what brought them to the ED to begin with, such as treatments for nausea and vomiting; education about physical symptoms and nutrition-related needs during pregnancy; and referrals to prenatal care. However, we find evidence of unmet needs related to patient-centered communication, such as providing emotional care to women discovering pregnancies in EDs and lack of support for transitions to abortion care. CONCLUSIONS While diagnosis of pregnancy in the ED may be routine for ED clinicians, it is not necessarily routine or straightforward for people receiving the diagnosis. ED clinicians should not assume that all people who discover their pregnancies in the ED want to continue their pregnancy. People who discover pregnancies in EDs may benefit from patient-centered communication and support for the range of transitions to care people might need in addition to the routinely provided diagnostic and therapeutic interventions. IMPLICATIONS ED clinicians may need additional training and support to ensure that they can meet the range of needs of people who discover their pregnancies in the ED.
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Affiliation(s)
- Sarah C.M. Roberts
- Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, University of California, San Francisco, Department of Obstetrics, Gynecology & Reproductive Sciences
| | - Erin Wingo
- Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, University of California, San Francisco, Department of Obstetrics, Gynecology & Reproductive Sciences
| | - Katrina Kimport
- Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, University of California, San Francisco, Department of Obstetrics, Gynecology & Reproductive Sciences
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18
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Kimport K. Pregnant Women's Reasons for and Experiences of Visiting Antiabortion Pregnancy Resource Centers. PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2020; 52:49-56. [PMID: 32103617 DOI: 10.1363/psrh.12131] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 11/19/2019] [Accepted: 11/30/2019] [Indexed: 06/10/2023]
Abstract
CONTEXT The primary mission of pregnancy resource centers is to dissuade women from choosing abortion. Reproductive health and rights advocates have asserted that these centers interfere in abortion decision making. However, the reasons pregnant women go to such centers and what they experience while there have not been examined. METHODS Between June 2015 and June 2017, in-depth, semistructured phone interviews were conducted with 21 pregnant women who had presented at prenatal care clinics in southern Louisiana and Baltimore, Maryland, and who had visited a pregnancy resource center. Topics covered in the interviews included reasons for visiting a center and the experience of the visit. Transcripts were analyzed first thematically and then using grounded theory. RESULTS Most of the women were low income and had not been considering abortion when they visited a pregnancy resource center. Respondents reported that they had gone to these centers for pregnancy-related services, material goods and social support. They chose these centers because the resources were free, and they were largely satisfied with their experiences. Nonetheless, their receipt of services and goods was limited and often contingent on participation in the centers' activities. CONCLUSIONS Pregnancy resource centers play a role in meeting the acute material and social needs of low-income pregnant women. However, the constraints on the resources the centers offer mean that this support cannot be part of a reliable system of care. Advocates and policymakers should take a nuanced approach to regulating these centers and consider the reasons women visit them, especially low-income women.
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Affiliation(s)
- Katrina Kimport
- Advancing New Standards in Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco
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19
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Roberts SCM, Berglas NF, Kimport K. Complex situations: Economic insecurity, mental health, and substance use among pregnant women who consider - but do not have - abortions. PLoS One 2020; 15:e0226004. [PMID: 31940311 PMCID: PMC6961826 DOI: 10.1371/journal.pone.0226004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 11/07/2019] [Indexed: 12/02/2022] Open
Abstract
We examine characteristics and experiences of women who considered, but did not have, an abortion for this pregnancy. Participants were recruited at prenatal care clinics in Louisiana and Maryland for a mixed-methods study (N = 589). On self-administered surveys and structured interviews, participants were asked if they had considered abortion for this pregnancy and, if so, reasons they did not obtain one. A subset (n = 83), including participants who considered abortion for this pregnancy, completed in-depth phone interviews. Multivariable logistic regression analyses examined characteristics associated with having considered abortion and experiencing a policy-related barrier to having an abortion; analyses focused on economic insecurity and of mental health/substance use as main predictors of interest. Louisiana interviews (n = 43) were analyzed using modified grounded theory to understand concrete experiences of policy-related factors. In regression analyses, women who reported greater economic insecurity (aOR 1.21 [95% CI 1.17, 1.26]) and more mental health diagnoses/substance use (aOR 1.29 [1.16, 1.45] had higher odds of having considered abortion. Those who reported greater economic insecurity (aOR 1.50 [1.09, 2.08]) and more mental health diagnoses/substance use (aOR 1.45 [95% CI 1.03, 2.05] had higher odds of reporting policy-related barriers. Interviewees who considered abortion and were subject to multiple restrictions on abortion identified material and instrumental impacts of policies that, collectively, contributed to them not having an abortion. Many described simultaneously navigating economic insecurity, mental health disorders, substance use, and interpersonal opposition to abortion from family and the man involved in the pregnancy. Current restrictive abortion policies appear to have more of an impact on women who report greater economic insecurity and more mental health diagnoses/substance use. These policies work in concert with each other, with people’s individual complex situations–including economic insecurity, mental health, and substance use–and with anti-abortion attitudes of other people to make abortion care impossible for some pregnant women to access.
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Affiliation(s)
- Sarah C. M. Roberts
- Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology & Reproductive Sciences University of California San Francisco (UCSF), San Francisco, California, United States of America
- * E-mail:
| | - Nancy F. Berglas
- Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology & Reproductive Sciences University of California San Francisco (UCSF), San Francisco, California, United States of America
| | - Katrina Kimport
- Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology & Reproductive Sciences University of California San Francisco (UCSF), San Francisco, California, United States of America
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20
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The Health and Social Service Needs of Pregnant Women Who Consider but Do Not Have Abortions. Womens Health Issues 2019; 29:364-369. [DOI: 10.1016/j.whi.2019.07.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 07/03/2019] [Accepted: 07/03/2019] [Indexed: 11/24/2022]
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21
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Kavanaugh ML, Jerman J, Frohwirth L. "It's not something you talk about really": information barriers encountered by women who travel long distances for abortion care. Contraception 2019; 100:79-84. [PMID: 30980828 DOI: 10.1016/j.contraception.2019.03.048] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 03/24/2019] [Accepted: 03/27/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE For individuals traveling significant distances for time-sensitive abortion care, accurate information about service options and locations is critical, but little is known regarding information barriers that individuals may encounter and strategies for circumventing these barriers. STUDY DESIGN In early 2015, we conducted in-depth interviews with 29 patients who had traveled for abortion care at six facilities in Michigan and New Mexico. We identified information-related barriers that respondents encountered in understanding their pregnancy options and/or where to obtain an abortion between the time of pregnancy discovery, including any contact with a crisis pregnancy center, to the day of the abortion procedure through inductive and deductive analysis. RESULTS We identified two logistical information-related barriers - a general lack of reproductive-related knowledge and unhelpfulness on the part of perceived members of the healthcare community - and one broader barrier of perceived stigma within respondents' narratives. Of the seven respondents who did not encounter a logistical information-related barrier, having previous personal or close experience with abortion and internet savviness were both identified as strategies enabling them to circumvent the barriers. CONCLUSION Lack of clear, easy-to-find and accurate information about abortion services and availability represents a key barrier to obtaining an abortion; health care providers play a crucial role in ensuring pregnant patients' right to informed consent within reproductive health care delivery. IMPLICATIONS Women's health care providers should provide their patients with the full spectrum of resources and referrals for pregnancy and abortion care; recent federal guidelines proposing to restrict abortion counseling and referral at Title X-funded facilities would only exacerbate the current challenges that pregnant patients encounter when seeking abortion-related information and further decrease linkages to timely, desired abortion care.
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Affiliation(s)
| | - Jenna Jerman
- Planned Parenthood Federation of America, New York, NY, USA
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22
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Potter JE, Stevenson AJ, Coleman-Minahan K, Hopkins K, White K, Baum SE, Grossman D. Challenging unintended pregnancy as an indicator of reproductive autonomy. Contraception 2019; 100:1-4. [PMID: 30851238 DOI: 10.1016/j.contraception.2019.02.005] [Citation(s) in RCA: 90] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 02/13/2019] [Accepted: 02/14/2019] [Indexed: 12/21/2022]
Affiliation(s)
- Joseph E Potter
- Texas Policy Evaluation Project, 305 E. 23rd Street, Stop G1800, Austin, TX, 78712; Population Research Center and the Department of Sociology, University of Texas at Austin, 305 E. 23rd Street, Stop G1800, Austin, TX, 78712.
| | - Amanda Jean Stevenson
- Texas Policy Evaluation Project, 305 E. 23rd Street, Stop G1800, Austin, TX, 78712; Department of Sociology, University of Colorado Boulder, UCB 327 Ketchum 195, Boulder, CO, 80309
| | - Kate Coleman-Minahan
- Texas Policy Evaluation Project, 305 E. 23rd Street, Stop G1800, Austin, TX, 78712; University of Colorado College of Nursing, 13120 East 19th Avenue, Aurora, CO, 80045
| | - Kristine Hopkins
- Texas Policy Evaluation Project, 305 E. 23rd Street, Stop G1800, Austin, TX, 78712; Population Research Center and the Department of Sociology, University of Texas at Austin, 305 E. 23rd Street, Stop G1800, Austin, TX, 78712
| | - Kari White
- Texas Policy Evaluation Project, 305 E. 23rd Street, Stop G1800, Austin, TX, 78712; Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, 1720 2nd Ave South RPHB 320, Birmingham, AL, 35294
| | - Sarah E Baum
- Texas Policy Evaluation Project, 305 E. 23rd Street, Stop G1800, Austin, TX, 78712; Ibis Reproductive Health, 1330 Broadway Suite 1100, Oakland, CA, 94612
| | - Daniel Grossman
- Texas Policy Evaluation Project, 305 E. 23rd Street, Stop G1800, Austin, TX, 78712; Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, 1330 Broadway Suite 1100, Oakland, CA, 94612
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