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Hollenberger JC, Madden EE. "At the End of the Day it's Their choice": An Exploratory Qualitative Study of Pregnancy Options Counseling. SOCIAL WORK IN PUBLIC HEALTH 2024; 39:234-249. [PMID: 38421683 DOI: 10.1080/19371918.2024.2322594] [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: 03/02/2024]
Abstract
This study's purpose was to explore the current models and approaches of pregnancy options counseling across three types of agency settings in a Northeastern state. Additionally, this study aimed to determine if individuals who receive pregnancy options counseling obtained medically factual, non-directive, and non-biased information needed to make informed decisions related to their pregnancy decisions. Using qualitative research methodology, semi-structured interviews were conducted with 10 participants across three different agency settings in one state in the Northeastern United States. Results indicated agencies shared a definition of pregnancy options counseling. Outcomes also suggest agency type impacted how pregnancy options counseling was delivered, as variations were found in education provided to patients. Lastly, the interviews imply no standardized model or training for pregnancy options counselors is currently being used.
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Affiliation(s)
| | - Elissa E Madden
- Diana Garland School of Social Work, Baylor University, Waco, TX
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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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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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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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Chan E, Korotkaya Y, Osadchiy V, Sridhar A. Patient Experiences at California Crisis Pregnancy Centers: A Mixed-Methods Analysis of Online Crowd-Sourced Reviews, 2010-2019. South Med J 2022; 115:144-151. [PMID: 35118505 DOI: 10.14423/smj.0000000000001353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Crisis pregnancy centers (CPCs) are nonprofit antiabortion organizations that claim provision of pregnancy resources. With the Reproduction Freedom, Accountability, Comprehensive Care, and Transparency Act repealed, CPCs are no longer mandated to share information on state-funded family planning and abortion services. As patients increasingly seek healthcare guidance online, we evaluated crowd-sourced reviews of CPCs using the social networking site Yelp. METHODS CPCs were identified with the CPC Map, a geo-based location resource. Of California's 145 CPCs, 84% had Yelp pages, and 619 reviews (2010-2019) were extracted. Thematic codes were individually applied to 220 excerpts and then analyzed in detail using thematic analysis to capture emergent themes related to motivations for and experiences of CPCs. To ensure thematic saturation, we applied a natural language-processing technique called the meaning extraction method to computationally derive themes of discussion from all of the extracted posts. RESULTS Motivations to seek care from CPCs included pregnancy confirmation, gaps in healthcare coverage, parenting and emotional support, and abortion care. A review of experiences reveal that CPC faith-based practice garnered both positive- and negative-based experiences. Reviewers also articulated inaccurate medical information, lack of transparency, and reduced options at CPCs. CONCLUSIONS This is the first study to analyze California CPCs using a social media platform. Pregnant patients turn to social media to share experiences about pregnancy resources, to find healthcare providers, and to increase transparency of services. This content provides valuable insight into the concerns of pregnant patients and offers an intimate view of California CPCs at a time when no federal regulations are in place.
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Affiliation(s)
- Elaine Chan
- From the David Geffen School of Medicine at the University of California, Los Angeles
| | - Yelena Korotkaya
- From the David Geffen School of Medicine at the University of California, Los Angeles
| | - Vadim Osadchiy
- From the David Geffen School of Medicine at the University of California, Los Angeles
| | - Aparna Sridhar
- From the David Geffen School of Medicine at the University of California, Los Angeles
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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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"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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