Even as the Legislature passed a measure earlier this year protecting the right to an abortion in Vermont, several communities throughout the state are home to organizations that operate with the goal of convincing women not to terminate pregnancies.
The existence of these organizations, and the way they present themselves, has raised concern among some legislators and medical professionals who fear the centers mislead vulnerable women who are pregnant.
Carly Thomsen, professor of gender, sexuality and feminist studies at Middlebury College, said these centers, often called “crisis pregnancy centers” or CPCs, operate within the structure of the national anti-abortion movement, and that they are usually registered as religious nonprofits and funded at least in part by churches.
“Crisis pregnancy centers tend to view themselves as the provider arm of the anti-abortion movement. They are also the recipient of the vast majority of the anti-abortion movement’s activist hours and financial resources,” she said. “This is according to what CPCs and the anti-abortion movement says about itself.”
According to Joanie Praamsma, executive director of the Pregnancy Resource Center of Addison County, there are roughly six centers like hers in the state. Among them is the First Step Pregnancy Clinic in downtown Rutland, previously First Step Pregnancy Center. The clinic’s name change has raised concerns among critics who argue it was designed to mislead the public into believing it is a health care provider.
David Wilkinson, a pastor and the executive director of First Step, said the name change reflects the fact that the clinic now offers ultrasounds to pregnant clients on a donated machine.
“By adding a medical procedure like ultrasound, we transitioned to becoming a medical clinic,” he said. “We have trained nurses in ultrasound to do the pregnancy testing as well as the ultrasound exam. Since those are medical procedures we’ve decided to change the name to a pregnancy clinic to reflect that we are now doing those procedures.”
The center also offers counseling sessions and parenting classes, and they run a baby boutique where clients can spend credits they earn during the courses.
Wilkinson said he has received no direct pushback regarding the name change, and that the center’s volunteer medical director is still in the process of training four nurses on the machine. One of the nurses is a volunteer with the Pregnancy Resource Center of Addison County, and Wilkinson said the two centers plan to share the machine.
Despite the addition of the ultrasound machine, some worry that the term “clinic” is deceptive for pregnant people searching for a more comprehensive set of medical services. While First Step offers ultrasounds and pregnancy tests, it does not offer sexually transmitted infection testing, contraceptives or other medical services offered by free clinics, doctor’s offices or Planned Parenthood.
Rep. George Till, D-Jericho, who is an obstetrician and gynecologist, said he believes it is misleading for crisis pregnancy centers to use the word clinic in their names.
“I have known individual patients who have been very distressed about their interactions with some of these places over the years and who thought they were going just for a counseling session about their options but instead were just browbeaten about the fact that they might consider abortion,” Till said. “If you’re there with a purpose, which is not to give people all the facts and a choice, but only steer them in a certain direction, that’s not ethical.”
The legal landscape
First Step Pregnancy Clinic has not violated any laws in changing its name. David Herlihy, executive director of the Vermont Board of Medical Practice, said most outpatient medical facilities, like clinics, do not need to comply with specific regulations in the state of Vermont. Rather, the boards that oversee doctors and nurses regulate individuals practicing medicine. Part of their job is addressing the unlicensed practice of medicine, which Herlihy said would include investigating doctors who are misleading patients.
“If you’re selling people snake oil and saying it will cure cancer, or whatever, we can potentially address that as unlicensed practice of medicine,” he said.
However, Herlihy said a crisis pregnancy center calling itself a clinic does not constitute this type of violation, though he stressed that every situation is case-dependent.
“Calling yourself a clinic in and of itself wouldn’t meet the standard,” he said. “I can’t imagine a situation when that simple representation or use of that word would give rise to a violation of the prohibition against unlicensed practice of medicine.”
According to Herlihy, the only way his board would be called in to oversee First Step or another crisis pregnancy center would be if somebody lodged a complaint about a licensed medical professional working or volunteering there.
The use of the word “clinic” also does not fall under the purview of the Vermont Attorney General’s Office’s Public Protection Division. Christopher Curtis, the division’s chief, said, “I am unaware that the term ‘clinic’ is a protected term, or statutorily mandated or prescribed by regulation.”
He added that nonprofits or entities that offer free services do not fall within the scope of the Consumer Protection Act, because they do not technically have consumers within the act’s definition.
‘I’m convinced that we don’t lie to women’
For his part, Wilkinson said his clinic does not give false information about the services it does not offer, including abortion. Rather, he described his mission as providing an alternative to abortion so women can chose another option.
“Any woman who comes to us, we’re going to lovingly and gently help her throughout her process to understand what her options are so she can make an informed decision,” he said.
Chanda McCarthy, a nurse at Rutland Regional Medical Center and a volunteer at the clinic, said there is nothing keeping pregnant women at First Step who want to go elsewhere.
“There is no door that shuts behind them and keeps them from leaving,” she said. “Being faith-based, we pray they make a decision to choose life but we know that’s not always the case but that does not hurt our relationship with that woman or that man. Our doors are still open to them no matter what their decision is in the end.”
Praamsma also said that her clinic does not mislead clients.
“I’m convinced that we don’t lie to women,” Praamsma said. “We want them to feel supported and we’re here to listen and if they still decide they want to have an abortion after we’ve helped them look at all of their options, that’s their decision. We’re not giving coercive information.”
However, Praamsma said staff and volunteers at her clinic discuss “abortion risks” with people who come in for counseling, including possible negative emotional and physcial side effects of the procedure — from depression to breast cancer to infertility — which have been almost universally debunked.
“We don’t focus on that a lot,” she said, “but just to say there are reports that there is a link between abortion and breast cancer or that there’s a link between having an abortion procedure and potential future issues around infertility and other complications.”
According to the American College of Obstetricians and Gynecologists, most doctors agree that having an abortion “does not affect your ability to get pregnant or the risk of future pregnancy complications.” They also note that “recent studies have shown no link between abortion and breast cancer. For women with an unplanned pregnancy, there is no difference in the risk of depression or other mental health problems between those who have an abortion and those who have the baby.”
‘Implication they make is … untrue’
In addition to misleading information, Thomsen stressed that even the suggestion that abortion hurts patients is harmful and incorrect.
One of the services First Step offers is post-abortion counseling, which Thomsen said falls into this category. On its website, First Step states that “many women who have had abortions report feelings of sadness, depression and regret” and the center offers the services of client advocates who trained in “counseling and listening skills,” though they “are not licensed or ‘professional’ counselors.”
Said Thomsen, “Even if they’re not using false statements or statistics, the implication they make is that abortion is harmful and if they are saying that abortion is harmful to women that is untrue.”
Thomsen added that, in her view, there is no reason for a pregnant person to visit a CPC instead of a pregnancy clinic or doctor’s office without pro-life ideological roots.
“There’s nothing that an ultrasound tech at the crisis pregnancy center could provide that is not provided at Planned Parenthood, which is far more regulated,” she said.
Praamsma, however, said her center and others like it offer a better option.
“The doctor doesn’t offer the same supportive environment,” she said. “We’re here to provide the supportive setting in a difficult situation.”
Thomsen disputed the notion that doctor’s offices and Planned Parenthood do not support pregnant patients adequately.
“I think that’s a flat-out lie that relies on a misrepresentation of the work that Planned Parenthood does, and is also rooted in the inaccurate idea that abortion harms women,” she said.
“Pregnancy resource centers do not have enough respect for the individuals who come in there to believe they know what is best for their lives. And I cannot fathom how someone could use the term supportive to describe approaches that involve using deception to further a political position.”
Thomsen said that despite the concerns over CPCs and their conduct, they can be hard to regulate. When challenged, such organizations often point to the First Amendment as protecting their work.
“When there are attempts to regulate CPCs, they consistently respond that this is a matter of free speech and religious freedom,” she said.
Till, the state representative and obstetrician, said he would worry about this defense if the Legislature tried to regulate CPCs at the state level.
“I fear that it would come down to a First Amendment fight about their freedom to say what they want to say, so I don’t know,” he said. “We’ve been asked on multiple subjects to please avoid First Amendment fights.”
In the meantime, Thomsen stressed that CPCs are growing in number nationwide.
“Over the last 40 years, the number of CPCs has increased substantially and the number of abortion clinics has decreased substantially, so now there are fewer than 900 abortion clinics in the country and there are more than 2,500 CPCs, and the trend used to be in reverse,” she said.
“When we’re talking about these CPCs in Vermont, it is really crucial to understand that even though they’re trying to make themselves feel local and that they are concerned with local communities, they are also fundamentally driven by a national anti-abortion agenda.”