Who attends a crisis pregnancy center in Ohio?

Reproductive gerrymandering, bureaucratic violence, and the erosion of abortion access in the United States

In the contemporary American political landscape, gerrymandering and the passage of anti-abortion legislation are intimately connected in what I call reproductive gerrymandering. I develop this concept as an analytic tool to understand the disjuncture between the passage of laws restricting reproductive healthcare access and the will of the majority of voters. In this ethnographic project, Ohio serves as an important case study where efforts to elect a supermajority of extremist anti-abortion Republican officials has allowed for the passage of unpopular legislation restricting abortion. I argue that the mundane bureaucratic processes involved in electoral redistricting and state budget procedures are forms of bureaucratic violence that result in structural harm experienced by pregnant people, especially those who are most marginalized. Reproductive gerrymandering provides a means for theorizing the connections across domains involving partisan redistricting, reproductive governance in the form of anti-abortion legislation, and the structural violence experienced by pregnant people seeking abortion.

"It Wasn't Very Public-Clinicy": Client Experiences at Faith-Based Pregnancy Centers

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.

Early pregnancy confirmation availability at crisis pregnancy centers and abortion facilities in the United States

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.

The Problems with Crisis Pregnancy Centers: Reviewing the Literature and Identifying New Directions for Future Research

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.