One afternoon last March, two young women paid a visit to the Women's Care Center on Orin Road. Located just across the street from a Planned Parenthood clinic, the Women's Care Center is a crisis pregnancy center, designed to offer women facing an unplanned pregnancy alternatives to abortion.
Amanda Geske, an intern with NARAL Pro-Choice Wisconsin Foundation at the time, was posing as a friend of Sarah (not her real name), who was pretending to be pregnant. They were at there as part of an investigation by NARAL, an abortion rights group, of Wisconsin's crisis pregnancy centers and hotlines. The group's report, CPCs Exposed: The Truth About Deception at Wisconsin's Crisis Pregnancy Centers, was provided exclusively to Isthmus, as were audio recordings and written reports.
According to audio of that March visit to the Women's Care Center, Sarah told a counselor that she already had a young child, was in school and didn't think she had the time or resources to raise another child at this time.
The counselor asked Sarah what she would do in an "ideal world" without "pressure from anyone else. What would you want?"
"I want this pregnancy to not happen," Sarah responded.
The counselor asked when Sarah was due and challenged her assumptions about not being able to manage another child. She offered to talk about making an adoption plan and walk her through abortion procedures.
Sarah said she could not consider adoption and asked for more information about her options. "Abortion?" the counselor asked.
"I think one of two things happen for women who have an abortion," the counselor continued. "There are women who experience intense grief, intense pain after an abortion. There are also women who experience that and don't talk about it. If you were hurting and struggling, would you ever be able to talk about it?"
When Sarah asked where she could get an abortion, the counselor said her organization does not provide referrals for the procedure. "And it's just because we see a lot of women come into us after they've had them, and they're struggling a lot afterwards. Our goal is to educate you completely, inform you completely, so you can make an educated choice."
Even when Sarah asked if the Planned Parenthood facility directly across the street provided abortions, which it does, the counselor stayed mum.
"I think you would have to call there to find out," she said. "I can't in good faith refer you. I've seen abortions hurt women. I really have."
The counselor then ticked off a list of risks she said were associated with abortion, including "very heavy bleeding," "infection," "perforation of the uterus, which can cause infertility later in life," and "emotional and psychological pain that comes along... later."
Women's Care Center, like most crisis pregnancy centers, claims that it offers information on all choices available to women. Yet critics say that these centers provide inaccurate and misleading information on abortion to dissuade women from terminating a pregnancy. Many of these centers are faith-based and object to abortion based on religious grounds.
The Women's Care Center, in fact, was started by anti-abortion activists who protested in front of the Planned Parenthood building, according to an article in the Madison Diocese's newsletter, Catholic Herald. Seeing a "for sale" sign on the property directly across the street, and "after a nine-day novena of prayer, the couple discerned that God was calling them to purchase this property for the cause of saving babies."
As state restrictions have made abortion harder to obtain around the country -- 87% of U.S. counties have no abortion providers, according to the Guttmacher Institute, which studies reproductive health policies -- crisis pregnancy centers have proliferated. While only four abortion clinics remain in Wisconsin, there are an estimated 80 crisis pregnancy centers in the state.
According to NARAL's CPCs Exposed, every one of the 10 crisis pregnancy centers visited by its volunteers in the Madison, Milwaukee and Janesville areas provided medically inaccurate information regarding "post-abortion syndrome" and the link between abortion and breast cancer. When emergency contraception was discussed, counselors told volunteers it was dangerous to their physical and/or mental health.
Lisa Subeck, the former director of NARAL Pro-Choice Wisconsin, says she launched the probe into Wisconsin's crisis pregnancy centers because similar investigations by NARAL affiliates in other states had found these centers dispensed misleading, inaccurate and incomplete information to women.
"The reality is it's not all options," says Subeck, a Madison alder who is now executive director of United Wisconsin. "We found women were not only encouraged not to have abortions, but were told horror stories. One volunteer was told she might not be able to listen to a vacuum cleaner again if she had an abortion. That is a fear-mongering tactic. It's certainly not what anybody in the mental health or medical community would consider all-options counseling."
In the hot seat
Robert Pearson is widely credited with opening (PDF) the nation's first crisis pregnancy center in 1967 in Hawaii. Pearson went on to found the St. Louis-based Pearson Foundation to help local groups set up crisis pregnancy centers.
In his 1984 manual, How to Start and Operate Your Own Pro-Life Outreach Crisis Pregnancy Center, Pearson advised that if an individual calls a center inquiring about abortion services, "there is nothing wrong or dishonest if you don't want to answer a question that may reveal your pro-life position by changing the caller's train of thought by asking a question in return."
According to a 2009 report (PDF) by the Family Research Council, an anti-abortion organization, there are 2,300 crisis pregnancy centers nationwide operated by three major faith-based organizations: Care Net, Heartbeat International and the National Institute of Family and Life Advocates.
These centers serve some 1.9 million clients a year with pregnancy assistance, abstinence counseling and education, community outreach programs and referrals, according to the report. Some offer such medical services as pregnancy tests and ultrasounds, but many do not.
There are at least two crisis pregnancy centers in Madison besides the Women's Care Center: Access Women's Center, 2701 E. Washington Ave., which is located right next door to a Madison Dane County Public Health clinic; and Care Net Pregnancy Center of Dane County, 1350 MacArthur Rd.
Care Net officials found themselves in the hot seat recently at a city committee meeting, where the group's request for funding for an affordable housing project was being considered.
Subeck charged the group with deceptive practices, as did Dane County Supervisor Carousel Bayrd. Care Net officials denied the charges, but the panel rejected the funding request, which city staff had recommended for approval.
On Jan. 25, Care Net's board president, Larry DeWerd, sent a four-page letter to the Community Development Block Grant committee responding to what he said were "unfounded allegations" made by Subeck and others. He said that Care Net provides "accurate and up-to-date medical information to those clients who request it."
When a NARAL volunteer, posing as a pregnant woman, sought counseling at Care Net last March, she reported in a site survey that she felt "ever so slight pressure to keep the baby/adopt," but that the counselors "did a pretty good job of staying very near neutral. They did encourage me taking time to really think hard about this decision, especially since abortion is so final."
A Focus on the Family pamphlet distributed at the center is far less neutral, warning that abortion will result in long-term guilt, self-destructive behavior and even "nightmares involving lost or dismembered babies."
Julie Bennett, Care Net's center director, says she remembers the visit from NARAL. A red flag went up when the volunteer asked whether abortion caused breast cancer, even though the counselors did not broach the topic.
Bennett says she told them that the evidence is not conclusive on that score.
A 2011 pamphlet distributed by Care Net's national organization, however, available at the clinic, is more forceful, claiming that "A number of reliable studies have concluded that there is an association between abortion and later development of breast cancer."
That conclusion is disputed by the National Cancer Institute. In February 2003, the institute brought together an international panel of 100 experts who study pregnancy and breast cancer risk. Workshop participants reviewed "existing population-based, clinical and animal studies on the relationship between pregnancy and breast cancer risk, including studies of induced and spontaneous abortions."
The experts concluded that "having an abortion or miscarriage does not increase a woman's subsequent risk of developing breast cancer." Subsequent review of newer literature has not changed the institute's conclusion.
'Health, hope and healing'
Rhonda Thompson, development director for Care Net Pregnancy Center of Dane County, says the group's mission is to provide compassionate pregnancy and sexual health services. "We offer health, hope and healing through medical services, education, a residential program and ongoing support and care," she says.
The group moved to MacArthur Road in 2005. The clinic is on the ground floor, and Elizabeth House, which houses pregnant women 18 to 26, is upstairs.
There are three counseling rooms in the clinic, including one tailored to men, complete with leather couch and a copy of Motor Trend magazine.
There are separate rooms where ultrasounds are performed, and a lab where pregnancy and sexually transmitted infection tests are run.
The largest counseling room has space for families to meet. It's also where clients can watch educational videos on everything from how to use an infant car seat to tips for dealing with toddlers. Clients are rewarded for watching these videos with baby clothes and personal-care items as part of an "Earn While You Learn" program.
Critics say these centers target young and low-income women with these giveaways, which are available only after clients have undergone counseling or watched videos. During a site visit at Access Women's Center, a NARAL volunteer reported she was offered maternity and baby clothes, prenatal care, prenatal support and living support, but only if she were to attend Bible study.
Care Net also sends individuals who meet with counselors home with gift bags. Thompson says clients who are undecided about whether they want to carry to term receive pampering items such as lotions and soaps; those who intend to carry to term receive a small toy, baby shampoo, a clothing item and a diaper.
Jasmine, who asked that her last name not be used, says she found it "almost traumatizing" when, as a 15-year-old pregnant girl, she sought out counseling at Care Net and was given a gift bag containing a diaper and other items. She ultimately decided to have an abortion, but felt the care package was meant to persuade her to continue her pregnancy.
But Jasmine says her recent experience with Care Net was "positive." Now 24, she became pregnant again last January. She says she was surprised, nervous, scared and overwhelmed. She turned to Care Net to get a pregnancy test and figure out what to do.
She says she received an ultrasound, talked through her options with a counselor and learned about community resources. She went home, decided to keep her baby and confided in her mother, who was "super excited."
"That made it easier to move forward on things," she says. Jasmine says she was skeptical of some of the classes Care Net offered but actually learned a lot.
Care Net officials say such experiences are typical. In exit surveys, according to the organization, "97% of our clients rated all of Care Net's services as very good or excellent."
According to audio recorded by NARAL volunteers and their post-visit surveys, counselors at the Women's Care Center and Access Women's Center appear to more aggressively deter women from obtaining an abortion than do those at Care Net. They are also more overtly religious in their counseling.
On one visit to Access Women's Center last March, a NARAL volunteer says she asked about abortion as an option but was told, "Your baby should not have to pay for your unwise decisions." The counselor told her that she could bleed out from an abortion and might never be able to have kids again. "We all will be judged by God, so we don't want to have any regrets."
The volunteer says she told the counselor she was Jewish but that she "seemed not to respect my religion." The counselor asked if the volunteer would be willing to become a Christian and if she could pray for her.
On another visit to Access, a NARAL volunteer stated that she had been sexually assaulted a few days earlier and during the visit asked about emergency contraception. The counselor, who identified herself as "Baptist" and "pro-life," said she couldn't tell the volunteer where to get it because it wouldn't be ethical. The counselor said emergency contraception, like abortion, takes a life, and warned the volunteer she would feel guilty if she ever had another child. She also asked her what was worse: rape or what she would be doing to her four-day-old baby.
"She said the rape was not God's will, but if I was pregnant it would be because of God's will," the volunteer wrote.
The NARAL report found that all of the crisis pregnancy centers visited advised, either during counseling or through literature they provide, that abortion leads to mental health problems, so-called post-abortion syndrome.
But two major comprehensive studies by the American Psychological Association have concluded otherwise. An August 2008 report (PDF) by the APA Task Force on Mental Health and Abortion found that "the best scientific evidence indicates that the relative risk of mental health problems among adult women who have an unplanned pregnancy is no greater if they have an elective first-trimester abortion than if they deliver the pregnancy."
The Guttmacher Institute notes that "the 'post-abortion traumatic stress syndrome' that abortion foes claim is widespread is not recognized by either the APA or the American Psychiatric Association."
Another comprehensive review of the scientific literature (PDF) conducted in 2008 by researchers at Johns Hopkins University, also found that "the highest-quality research available does not support the hypothesis" of a post-abortion traumatic stress syndrome. "Lingering post-abortion feelings of sadness, guilt, regret and depression appear to occur in only a minority of women."
Crisis pregnancy centers also appear to overplay the risks associated with abortion, especially relative to pregnancy.
Though some counselors at these centers warned about the risk of infection from tissue left in the uterus, an "incomplete abortion," which requires a repeat suction procedure, occurs in just .3% to 2% of all cases, according to a fact sheet distributed by the National Abortion Federation, which supports abortion rights. The federation also reports that while death occurs in 0.0006% of all legal surgical abortions, a woman's risk of death during pregnancy and childbirth is 10 times greater.
Greg Wagner, chair of the board of directors for Madison's Women's Care Center, says that it is hard to respond to NARAL's findings without seeing the report or to comment on parts of conversations recorded by someone who was undercover. But he says that through counseling the Women's Care Center tries to "lay out all the choices."
"Once a woman is pregnant there are three choices: abort the child, keep the child or give it up to adoption -- all have consequences," he says.
"Our philosophy is always that we try to maintain the dignity of the woman," adds Wagner. "That comes first and foremost. We're trying to help her make a decision she'll be happy with and won't regret."
Access Women's Center also defends its operation in a statement. "We make no apology for providing pregnancy option information to women genuinely seeking help and information -- at no cost to themselves and at no profit for ourselves. We inform clients of the scope and limits of our services and provide those services with their consent. The desire to love God with all our heart, mind and strength and to love our neighbors (born and unborn) as ourselves calls us to a high standard of service to the Madison community."
Many women find their way to crisis pregnancy centers through hotlines, billboards and Internet advertising. Chances are good that a Google search of "Madison + abortion" will yield listings at the top for crisis pregnancy centers, not legitimate abortion providers. In one recent search, a paid advertisement for Care Net topped the list. The ad began "Thinking about Abortion? - Info on abortion procedures & risks," and included the website for Care Net of Dane County. It promised "caring & confidential help 24/7."
Another search, a couple of days later, brought up a top listing for 123GiveLife, where a zip code search is provided for identifying a nearby crisis pregnancy center. Though it's run by Wisconsin Right to Life, the state's most powerful anti-abortion organization, its ad reads, "Wisconsin Abortion Info - Convenient locations & caring help."
NARAL says the results of its investigation show the need for regulation of such advertising through truth-in-advertising laws or required disclaimers. The group is also calling for legislation to ensure that women entering health care facilities are not harassed by crisis pregnancy counseling staff or "sidewalk counselors."
Jenni Dye, executive director of NARAL Pro-Choice Wisconsin, would also like to see a public education campaign "to make sure women who are going to a crisis pregnancy center know that when they walk in that door they are going to receive limited-scope, limited-options advice."
Dye says her group is going to pursue "bubble laws" to create a buffer zone around abortion clinics. She says this would protect women seeking abortion services from being harassed by individuals who try to divert them instead to nearby crisis pregnancy centers.
The idea, Dye says, "is to create an actual bubble of protection so that women can make their own choices."
Here is NARAL Pro-Choice Wisconsin Foundatin's complete report, CPCs Exposed: The Truth About Deception at Wisconsin's Crisis Pregnancy Centers.