In California, less than two-thirds of counties have an abortion clinic. But nearly 80% have at least one “crisis pregnancy center,” according to a database compiled by CalMatters.

Abortion rights advocates and lawmakers have long accused these centers — also known as anti-abortion centers — of coercing vulnerable people into remaining pregnant by misleading them about abortion procedures and contraceptive methods. In rural areas with acute primary care shortages, “crisis pregnancy centers” outnumber abortion clinics 11 to 2, a CalMatters analysis shows.

While center supporters vehemently deny the accusations about misleading pregnant people, they’ve become the next battleground for California lawmakers bent on protecting abortion rights and offering services for people who live in states where abortion is banned.

“They’re the next way in which the anti-abortion movement will try to stop people from getting access to abortion here,” said Assemblymember Rebecca Bauer-Kahan, a Democrat from San Ramon and member of the Women’s Legislative Caucus, which has spearheaded the state’s legislative push for enhanced abortion protections.

Regulating “crisis pregnancy centers,” however, has proven to be exceptionally challenging even in the nation’s self-proclaimed “abortion safe haven.”

“They’re the next way in which the anti-abortion movement will try to stop people from getting access to abortion here.”
— Assemblymember Rebecca Bauer-Kahan, Democrat from San Ramon

This legislative session, two bills attempting to regulate the centers died quietly in the Assembly Appropriations Committee, including one authored by Bauer-Kahan. Officially, no one knows why the bills were killed in the Legislature’s opaque suspense file maneuvers, in which votes are not public, but it’s no secret that Democratic lawmakers are fearful of passing laws that might spur litigation from abortion opponents. Even before the U.S. Supreme Court’s conservative majority overturned Roe v. Wade, abortion opponents had used the courts to steadily chip away at abortion protections.

“Even a state like California is treading very carefully,” said Margaret Russell, an associate constitutional law professor at Santa Clara University. “Who wants to waste public resources on a lawsuit going up to the Supreme Court with the risk that the law would become even worse?”

Alexandra Snyder, CEO of Life Legal Defense Foundation and former director of a pregnancy center in Santa Clarita, said the bills had clear “legal problems (and) constitutional problems” and would be “tied up in the courts at tremendous expense for the next five years.”

A “chilling effect”

At an Assembly Health Committee hearing in April, staff from the Alternatives Pregnancy Center in Sacramento dressed in hot pink — a color also frequently donned by the state’s abortion rights advocates — and lined up in opposition to a bill requiring the state Public Health Department to conduct an “awareness campaign” about reproductive health and abortion options.

The measure made no mention of pregnancy centers opposed to abortion, but public testimony accused them of manipulating women by advertising “abortion education” or counseling services that are a means to scare them away from abortion and of falsely claiming “abortion pill reversal” is scientifically tested. Abortion pill reversal — which involves giving patients high doses of the pregnancy hormone progesterone — is not supported by most doctors, including the nation’s leading association of pregnancy and women’s health specialists. The American College of Obstetricians and Gynecologists states the procedure is “unproven and unethical” because it has not been backed by clinical studies.

Three weeks later the measure was dead — a rare win for the anti-abortion movement in California.

“We didn’t go there to necessarily stop the bill. We live in California, we know that. We didn’t think that was possible, but it’s clearly possible,” said Heidi Matzke, executive director of Alternatives Pregnancy Center.

Even the measure’s author, Santa Clarita Democrat Pilar Schiavo, was surprised.

“I was disappointed,” Schiavo said. “It literally didn’t say anything about crisis pregnancy centers. That’s as safe a bill as you can get.”California legislators have struggled to regulate these centers since 2018, when the U.S. Supreme Court struck down a state law known as the FACT Act that required reproductive health centers to notify clients about abortion and birth control options. It also required unlicensed centers to tell clients they were not medical facilities. Anti-abortion groups opposed it, arguing “crisis pregnancy centers” should not be compelled to say something that conflicts with their religious beliefs. The justices agreed in a 5-4 vote, dealing a bruising blow to abortion rights nationwide.

California’s use of a “government-drafted script” violated the First Amendment’s freedom of speech protections, Justice Clarence Thomas wrote in the majority opinion.

“By requiring petitioners to inform women how they can obtain state-subsidized abortions — at the same time petitioners try to dissuade women from choosing that option — the licensed notice plainly ‘alters the content’ of petitioners’ speech,” Thomas wrote.

“Because we have this history of the reproductive FACT Act, I think people are really worried about creating bad precedent,” said Cathren Cohen, a staff attorney at the Williams Institute and the Center on Reproductive Health, Law, and Policy at UCLA. “The anti-choice movement is very litigious. They know the federal courts are on their side.”

What has resulted is a “chilling effect,” even in states like California, Cohen said.

“Who wants to waste public resources on a lawsuit going up to the Supreme Court with the risk that the law would become even worse?”
— Margaret Russell, associate constitutional law professor at Santa Clara University

At least one lawsuit has been filed in reaction to the flurry of abortion protections California passed last year. The claim, filed “on behalf of pro-life pregnancy care centers” by the Life Legal Defense Foundation, seeks to block the state’s requirement that health insurers cover abortion services with no out-of-pocket charges.

Cohen testified in support of Bauer-Kahan’s “crisis pregnancy center” bill during an Assembly Judiciary Committee hearing in March. That measure would have reinforced the state’s false advertising law to prevent facilities that provide pregnancy-related services from making false or misleading claims about abortion. It also allowed people who sought services and were harmed to later sue for damages.

The measure was carefully crafted to avoid the previous issue of compelled speech that prompted the Supreme Court to rebuke California, Cohen said, “but that doesn’t mean that it wouldn’t be challenged.”

Bauer-Kahan, who successfully passed two abortion protection bills last session, told CalMatters it’s unlikely she’ll reintroduce this measure but remains committed to exploring future options.

“It’s really important that we get our arms around it,” Bauer-Kahan said.

Conflicting narratives

So what happens inside a “crisis pregnancy center”? It depends on who you ask.

At the national level, abortion opponents don’t mince words when it comes to the goals of the centers: They exist to stop women from getting abortions. Convention trainings, e-books, and online courses from the largest anti-abortion center networks in the country offer strategies on how to talk to women who call asking about abortion.

At least three-fourths of California centers are affiliated with national organizations.

Proponents of the primarily faith-based nonprofits disagree with the characterization that their work is underhanded. Training materials from one of the largest networks in the country, Care Net, specifically say “manipulation is never an option,” though it recommends “speaking persuasively” as a “life advocate.”

Centers say they give women with unplanned pregnancies alternatives to abortion by providing material support: free diapers, parenting classes and sometimes housing.

“We are a safety net for women that want to carry,” said Marie Leatherby, president of the California Alliance of Pregnancy Care and executive director of Sacramento Life Center. “(For) most women, it’s just a great place to start your pregnancy.”

Leatherby said after the Supreme Court’s ruling, the organization worked hard to root out any “bad actors” that used deceptive practices. It requires members to state whether they are medically licensed facilities, and many disclose online that they do not provide or refer for abortions.

“We set the bar so high because we’re always scrutinized,” Leatherby said. “If they want to have the abortion, they are free to come and go. We let people know we don’t do that here but they can come in and sit and figure out what they want to do.”

Despite safeguards that Leatherby and other California center proponents say are in place to ensure women aren’t misled, it still sometimes happens.

“The anti-choice movement is very litigious. They know the federal courts are on their side.”
— Cathren Cohen, staff attorney at the Williams Institute and the Center on Reproductive Health, Law, and Policy at UCLA

Numerous journalism investigations across the country have detailed instances in other states in which women were tricked into walking into a center rather than a Planned Parenthood site, shown an altered ultrasound image, or more recently had their data tracked. Many make assertions about the risks of abortion, side effects of contraceptives, and efficacy of “abortion pill reversal” that may be grounded in research but are taken out of context.

For instance, many centers’ websites say emergency contraceptives like Plan B or ella cause early abortions of a fertilized egg, which has been debunked by multiple research studies. They also emphasize the potential for abortion to cause depression or other negative mental health impacts when decades of research indicate a wanted abortion “does not cause significant psychological problems,” according to the American Psychological Association.

Gabriel, a Sacramento-area resident, said she visited a pregnancy center in 2016 seeking an abortion. She was about six weeks pregnant with a minimum-wage job and no health insurance. She and her boyfriend struggled to provide for their toddler and knew they weren’t ready for a second kid, Gabriel said. She had already visited a Planned Parenthood but couldn’t afford its $450 out-of-pocket fee. Her boyfriend saw a pregnancy center advertisement and hoped it could do the procedure for free.

CalMatters agreed to use only Gabriel’s middle name to protect her privacy. Her family doesn’t know she sought an abortion.

The center worker promised to help over the phone and never indicated that it did not perform abortions, she said. Gabriel didn’t realize it was a religious organization until halfway through the 45-minute appointment, she said. The staff member gave her “random scary statistics like 80% of couples who go through abortion together break up” and told stories of people who regretted the decision — and waited until the end of the appointment to tell her the center did not do abortions.

Gabriel was so uncomfortable with her experience that she left a review on Yelp warning other women to be cautious.

“I was definitely stressed and embarrassed. The rational part of my brain told me this was part of their fear tactic, but at the same time he and I were only like 22 or something still trying to figure our lives out,” Gabriel said. “Naturally part of me was wondering if they were right about everything.”

The center “was kind of our last resort…and them not being able to help us in the way we needed, and on top of that being talked into something I know I didn’t want, was a lot of emotional pressure,” Gabriel said.

Reproductive health deserts

Increasingly, “crisis pregnancy centers” across the country are seeking to be licensed by state health departments. Approximately half of the centers in California are medically licensed facilities, according to the California Alliance of Pregnancy Care. Proponents say it helps fill a community need, while opponents say it gives women in reproductive health deserts even fewer choices.

“We have a looming primary care provider shortage in California,” Cohen said. “It’s apt to note that they’re filling a gap because we do need more reproductive health care providers, particularly in rural areas, low income areas, (and for) people of color.”

The breadth of medical services offered at centers opposed to abortion varies widely, with most performing only pregnancy testing and ultrasounds. The state does not set a minimum service requirement for licensing.

Only 10% of the California centers provide prenatal care and none offer contraceptives, according to a 2022 report by The Alliance, a national coalition of organizations supporting abortion rights. Last year, State Attorney General Rob Bonta issued a consumer alert warning that the centers do not offer comprehensive reproductive health care.

There are at least 176 “crisis pregnancy centers” in California, according to a CalMatters analysis. That compares to 166 abortion clinics, according to state data. At face value, the difference of 10 seems negligible, but pregnancy centers are more likely to be located in areas where there are primary care shortages. Abortion clinics, on the other hand, tend to be located in urban areas where primary care shortages are less likely. Clinics like Planned Parenthood also offer services like cervical cancer screenings, HIV treatment, gynecological care and annual exams.

In rural areas of the state where primary care is insufficient, people have a 25% chance of living near a “crisis pregnancy center” compared to a less than 5% chance of living near an abortion clinic, according to a CalMatters analysis.

More than 13.1 million state residents — roughly one third-of the state’s population — live in a primary care shortage area, according to the federal Health Resources and Services Administration.

Matzke, with Alternatives Pregnancy Center in Sacramento, takes particular issue with the claim that she runs a fake medical clinic.

“From the moment they walk in the door, I want them met with medical professionals,” Matzke said. “The moment they leave, I want them being walked out by medical professionals. And that’s who we are.”

Alternatives is licensed as a free clinic by the California Department of Public Health. The staff includes three doctors, five nurses, a nurse practitioner, a phlebotomist to draw blood and several medical assistants, Matzke said. In addition to pregnancy tests and ultrasounds, Alternatives offers sexually transmitted disease tests, gynecological care and prenatal care up to 25 weeks. The clinic does not conduct or refer for abortion: It says so on the front door.

“Every woman knows where to go to get an abortion. You know, you can go to Planned Parenthood…but most women don’t know that free resources like ours exist,” Matzke said.

In some ways Alternatives is an outlier among centers in California, offering more medical services than most. In other ways, it’s not. It does not provide contraceptives. It also advertises “abortion pill reversal.”

Although most doctors reject abortion reversal, plenty of pregnancy center advocates claim it worked for them. Atoria Foley, a patient of Alternatives who testified against Assemblymember Schiavo’s bill, took the abortion pill mifepristone, which blocks absorption of progesterone, on two separate occasions, she said. She felt pressured into getting an abortion by her child’s father, she said, and immediately regretted it. The clinic staff got her a prescription for progesterone, she said, and her daughter was born roughly seven months later.

“There’s not any sort of condemnation or shame around that. It’s just, let’s take care of you and love on you and guide you through this,” Foley said.

According to a scientific review, between 8% and 46% of medication abortions are unsuccessful if the pregnant person does not take the second pill, which causes the uterus to contract and expel its contents, similar to a miscarriage. The first randomized control study of abortion pill reversal in the U.S. was stopped in 2020 after several participants were hospitalized for uncontrolled bleeding, according to study authors.

Abortion rights advocates are adamant: Pregnancy centers have no place in California. They are a “physical manifestation of the anti-abortion movement,” Schiavo said. Betsy Butler, a former state senator and executive director of the Women’s Law Center at UCLA, which contributed to The Alliance report, agreed.

“How do we reign them in? Why are they allowed to impact women like this? What can the state do about that? We have to answer this question,” Butler said.

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CalMatters.org is a nonprofit, nonpartisan media venture explaining California policies and politics.