At 20 years old and four weeks pregnant, Angel Kai found herself sitting on a brown couch, with two older women praying over her. “They said something like, Dear heavenly father, thank you for blessing Angel with this beautiful baby — we hope for a healthy pregnancy,” Angel Kai remembers. “It was very awkward.”
Angel Kai, who asked us not to use her last name for privacy reasons, was at a facility in Amarillo, TX, known today by the name Hope Choice. Inside Angel Kai remembers being surrounded by imagery of crosses and women with pearly white smiles holding calm children. This wasn’t exactly what parenthood always looked like, Angel Kai knew — she’d given birth only three months before to her second child. Money was tight, especially since she’d gone on unpaid maternity leave; she knew Hope Choice provided free services and they'd always been kind enough to her when she’d visited the center before for free baby clothes and diapers. That’s why she’d come back for a free pregnancy confirmation. She didn’t expect to be judged.
But after the workers verified she was pregnant, Angel Kai said she was considering abortion. That’s when the mood shifted from simply "awkward" to exceptionally tense.
Hope Choice, which previously used the name CareNet Pregnancy Centers and Mentoring Programs, is one of thousands of “crisis pregnancy centers,” or CPCs, in the U.S. — which are also sometimes called “pregnancy resource centers.”
CPCs have been criticized for employing deceptive marketing and advertising tactics that may lead people to believe they’re medical centers — and to think that they support folks in obtaining abortions. As such, people often visit CPCs with misconceptions about their mission and services, even if their websites have fine-print disclaimers saying they don’t do abortions. Sometimes CPCs are peddling straight-up medical misinformation, disinformation, and incorrect claims about the “dangers” of abortion and about contraception. They typically aim their services at young and lower-income people who are lured in by the promise of free care. And CPCs, which often get funding from state legislatures, can be one particularly harmful source of misleading information about abortion in a growing sea of false and problematic messaging.
And all this is swirling in the tide of an America known for its poor sex education curriculum. Only 17 states require that what’s taught in sex ed be medically accurate, and 29 states necessitate that abstinence be stressed, according to the Guttmacher Institute. Abstinence-only education has been shown to be ineffective, and all this leaves teens unequipped with accurate information about pregnancy and abortion as they trudge through a world chock-full of distorted narratives on the subjects. In some cases, the “educational” arms of CPCs have even been contracted to teach sex education in public schools, despite the fact that most CPCs have religious affiliations and policies against promoting contraception. This is actually “very common,” says Andrea Swartzendruber, PhD, MPH, an associate professor at the College of Public Health at the University of Georgia.
Angel Kai remembers taking a sex ed class in fifth grade, but she didn’t get much information on the subject after that. When she found out she was pregnant again at the CPC years later, the same workers who’d always been welcoming to her turned stone serious when they discovered she was considering abortion, she remembers. They emphasized to her that abortion was “murder." Angel Kai eventually told the workers she wouldn’t have an abortion.
In a response to a request for comment, Candy Gibbs, executive director of Hope Choice, told Refinery29, “We are a Christian organization and prayer is something we certainly do.” She declined to comment on whether staffers would have called abortion “murder” or the description of Angel Kai being treated differently after disclosing she was considering abortion. “All of our pregnancy-related services are free and confidential,” Gibbs told Refinery29. “We have many volunteers who are caring people who simply want to help women and families who find themselves in difficult and overwhelming situations.”
Gibbs is right about this: those who are facing unplanned pregnancies are in “overwhelming” predicaments. Indeed, they're often in "crisis." And this leaves them especially vulnerable.
Angel Kai’s situation is more common than you’d think — crisis pregnancy centers outnumbered abortion clinics three to one even before Roe v. Wade — which protected a person's right to choose abortion without excessive government restriction — was overturned. And that gap is expected to grow. This will especially impact youth, lower-income people, and Black, Indigenous, and people of color who may be in need of care the most, says Dr. Swartzendruber. “Marginalized groups also have less access to healthcare,” she adds. “CPCs particularly target these groups.”
Meanwhile, CPCs seem to be clustered nearby colleges and other places where young people live. Preliminary analyses suggest this is true in Georgia, according to Dr. Swartzendruber, who co-developed the Crisis Pregnancy Center Map, a database that shows where these facilities are located across the country. CPCs are also targeting young students online. “We’ve noticed that more CPCs have sections on their websites specifically dedicated to poor students, and include directions and maps on how to get to the CPC from the local high schools or colleges,” says Danielle Lambert, PhD, MPH, an assistant professor at the College of Public Health at the University of Georgia and co-developer of the CPC map. She adds that some CPCs affiliate themselves with groups on campuses.
Plus, some centers take out ads in student newspapers. Others hang banners advertising their services in malls. They've shown up on Snapchat's Snap Maps. And students aren’t prepared through sex ed to easily see through misleading information that’s being placed directly in their lines of sight. In turn, they “will struggle to differentiate between what’s right for them versus what’s being sold to them,” says Justine Ang Fonte, M.Ed, MPH, a sex educator and professor with a focus on intersectionality.
In an ideal world, sex ed would serve as a non-judgmental source of information regarding pregnancy options including parenting, adoption, and abortion, as many young people don’t learn about this at home. However, many programs — particularly “abstinence-only” ones that may be connected to CPCs in some cases — don’t even give students the tools they need to properly prevent pregnancy.
Most curricula also omit what can be life-saving information about abortion care — and six states outright prohibit discussion of abortion in the classroom, according to the advocacy and policy organization SIECUS: Sex Ed For Social Change. If kids do get a lesson on abortion, it’s often biased or includes misinformation.
Yet learning about it could change — and even save — lives.
If you’re taught about all your options in school, then “if you end up at CPC or are dealing with a person who is guilting you or manipulating you to feel a certain way about abortion by saying it’s anything other than basic healthcare, you then have tools to know better than to listen to them, and to make a decision that’s right for you and your health,” Fonte says. This is crucial, as some people have no choice but to go to CPCs. Angel Kai, for example, kept going to Hope Choice for the free services, even after she was getting a feel for their stances on abortion. She couldn’t afford not to.
For these reasons, more literacy on abortion and reproductive health is needed, and schools need to be more discerning about who’s teaching teens what. Without these changes, some students will struggle to differentiate between what’s true, false, and biased.
Olivia Julianna, a 19-year-old Texas college student, may be an exception to that rule. The political strategist for the youth-led nonprofit Gen Z for Change, Julianna says she never learned anything about abortion growing up in her Christian conservative household and community, except that it was “evil.” She was glad she took a debate class in high school that prompted her to do her own research on the subject — she studied it for a competition and was able to piece together that the narrative she’d been hearing her whole life was far from accurate. She never actually got to debate her classmates on abortion (in competition, she had to present a different topic), but used what she learned later in her advocacy and awareness work.
But Julianna knows many people don’t ever get the opportunity to dig into the subject of abortion the way she did in high school. And if they find themselves in need of an abortion, they might be more likely to fall for misleading ideas that come out of CPCs. And there are plenty of those.
A 2014 study found that 80% of CPC websites contained at least one false or misleading piece of medical information, commonly linking abortion to mental health risks or future fertility issues. State Rep. Donna Howard (D-TX) tells Refinery29 that she’s seen such misinformation firsthand at CPCs in Texas, which are mostly funded by a state program called “Alternatives To Abortion,” which has an approved budget of $100 million for 2022 and 2023 (Rep. Howard calls this a “waste of taxpayer money”). She adds that CPCs in her state make claims that don’t have substantial, peer-reviewed research to back them up. For example, some say abortions can cause breast cancer, a claim that the American Cancer Society notes is not backed up by research studies.
It’s not always easy to track what the CPCs are telling people, and the impacts of what is said can be stark, says Morgan Gale, 25, who did their senior thesis research studying crisis pregnancy centers while attending Bowling Green University in Ohio. During their research, Gale says they went to The Pregnancy Center of Greater Toledo to see objectively what the care would be like. Before taking a pregnancy test, Gale says they were asked what they would do if they were pregnant. Gale said they’d have an abortion. Later, their test came back negative, but a staffer told Gale that it could have been too early for the test to pick up pregnancy. According to a transcript of audio Gale recorded during their visit reviewed by Refinery29, the staffer told Gale: “If you come back and you have a positive test and you still haven’t had your period, we can set up a free ultrasound… it would show you if it’s a pregnancy that’s really going to be viable, that’s going to live, because a lot of pregnancies end in miscarriage anyway, and you’d be paying $400 to $500 for a procedure that might not end — you know, that might end itself anyway.”
“I learned that’s a delay tactic they use so that people get farther along and it’s harder and more expensive for them to access abortion later,” Gale tells Refinery29.
Savannah Marten, the executive director of The Pregnancy Center of Greater Toledo tells Refinery29 via phone that the language Gale said was used regarding miscarriage is “totally outside of [their] policy.” “I do know there are some organizations that are similar to ours that would say that, but we emphatically do not use that language,” says Marten. “We are not in the business of saying scare tactics.” Marten adds that the center’s clientele is mostly aged 17 to 24, but they don’t “target” this group.
Marten says that the center believes that many other CPCs go too far with deceptive marketing and ads. “We wish that pregnancy centers nationally would step outside of that,” she says. “We firmly believe in informed consent, we want women who are walking through our doors to know what we are and aren’t.” That’s why, she says, when people call the center, workers tell them that they don’t refer or perform abortions.
In the U.S., many CPCs are affiliated with national organizations, including Care Net (Hope Choice was previously but is not currently affiliated with Care Net, Gibbs says) and Heartbeat International, according to a 2020 article published in JMIR Public Health and Surveillance, which was co-authored by Dr. Swartzendruber and Dr. Lambert, who conducted their research in Georgia. Aside from getting funding from state grant programs, “most states also raise funds for CPCs through the sale of “Choose Life” license plates,” Dr. Lambert says. “And still other CPCs have received funds through other federal programs such as Title X and school-based abstinence-only sex education programs.” Those who want to learn more about how CPCs in their state are funded can call their legislators, and contact their local school boards to see if CPCs are involved in sex ed or other programming.
Since Roe v. Wade was reversed, laws have been changing rapidly, causing confusion — and, thus, even more misinformation. That’s why having trusted spaces to learn accurate information about abortion are even more crucial now, Fonte says. This will especially be true as the ratio of CPCs to abortion health centers becomes even more disproportionate as abortion access is banned or restricted in up to half the states in the U.S.
Some legal scholars, including Mary Ziegler, a professor of law at UC Davis, worry about what will become of the personal data collected by CPCs in a post-Roe world. And that some people may end up at CPCs after traveling long distances out of state, thinking they can have abortions there. This may further delay their care and possibly prevent them from having their abortions at all — especially if they’ve already overcome the expenses and logistical barriers of traveling once, only to find they have to come back for a real appointment (if they don’t opt to self-manage their abortions).
The fact is, most people don't know much about their options for abortion until they’re facing an unplanned pregnancy. This was the case for Hanna Huff, 30, who went to Hope Choice (then known as CareNet) in 2013 after finding out she was pregnant and Googling where to go. At the time, she remembers thinking it was a doctor’s office. After a sonogram, “they said it was an ectopic pregnancy, and that I shouldn't worry about it,” she says. “They said the pregnancy wasn't real.” Huff says she didn’t know what “ectopic” meant then, but after looking it up, she was worried. She talked to her older sister, who tells Refinery29 she remembers being “shocked” by Huff’s experience and trying to help her make a follow-up appointment at a Planned Parenthood clinic in Lubbock, TX. Huff got a second opinion from a doctor, who said her pregnancy wasn’t ectopic after all. She ultimately chose adoption. Huff adds that Hope Choice has done “mentoring” programming at Huff’s niece’s school.
“We are not a doctor’s office and have never portrayed ourselves as such,” Gibbs told Refinery29 in response to a request for comment. Although she wouldn’t comment on the specifics Huff shared, she said: “We do not do medical diagnosis. If we believe that someone has an ectopic pregnancy we would send them for immediate medical care because ectopic pregnancies are life threatening and they are real.”
When people just Google "abortion in X City," as Huff says she did, they can easily end up at a CPC, especially if they're in a panicked state and not looking at the fine print. This is why advocates recommend resources such as I Need an A and AbortionFinder.org, which filter out CPCs for those searching for abortion options. Fonte adds that learning about these tools in school or sex ed would be helpful.
To get specific, when you Google “abortion amarillo TX,” Hope Choice, where Angel Kai and Huff went, is the sixth search result (as of press time). The first one also doesn’t perform or refer abortions. A Google spokesperson told Refinery29 that web page listings “are based on relevance to the keywords in a search.” “In this case, because there are no abortion providers in the area, web pages that talk about abortions in Amarillo like the example you provided are mentioning that word,” the spokesperson added. The tech company has made recent efforts to clarify whether organizations provide abortions or not.
Hope Choice’s Google description says Hope Choice “empowers you with the information and support you need to make a decision about your pregnancy.” “The first time I went in, I would have thought you could get information on both [adoption and abortion],” Angel Kai says. Only when she fully experienced the services for the first time did she see a plaque that said they don’t perform or refer abortions. For the record, Hope Choice does currently say on their website that they don’t do abortions and that they want to help clients “choose life.” But the site also proclaims: “If you are considering abortion, know that we are here for you.”
And Gibbs, the executive director, seems to really believe in this messaging. “I came to this very Center when I found myself pregnant in high school,” she tells Refinery29 via email. “I took a test and learned that I was pregnant. The staff at that time was very kind to me, they offered to help in any way they could and they did pray with me.” (This echos what happened to Angel Kai.) But after this experience, Gibbs says that she had an abortion, which impacted her mental health and family life negatively. “Two years later, I came back to the pregnancy center to attend a support group for women who have had abortions,” she says. “I was never treated with judgment or condemnation and the care and support I received is the reason that I have chosen to work at the pregnancy center for more than 27 years.”
Angel Kai did eventually end up getting the abortion she needed, a week later in New Mexico. Although she told the women of Hope Choice she wouldn’t do it, she says she knew it was the right choice for her and essentially said what she needed to say to get out of the center with minimum fuss, she says. But after having her abortion, she returned to Hope Choice later on for the free help with diapers and other resources for her other children. When staff figured out she didn’t have the baby, she remembers them being flat-out rude to her. “They were treating me very differently, and it was very shady,” she says.
Angel Kai was never taught about abortion as an option in her brief experience with sex ed and says that if she’d learned more about the nuanced politics around the issue, she would have done some things differently. For example, she certainly wouldn’t have told the folks at Hope Choice that she was considering abortion, she says. “I would have told them I was going to keep it the whole time instead of telling them what I was going to do,” she says. “My whole approach would have been different.”
And a change of approach — for young people, for many sex educators, and for those who mandate what can be taught in sex ed curricula — is desperately needed. Especially as we wade through waters of misinformation that are murkier than ever before.