For a PDF version of this factsheet with footnotes, please see below.
Women face many obstacles to receiving comprehensive, affordable, quality health care, including when individuals and institutions refuse to provide health care services. Some even go so far as to refuse to inform women about their health care options or even to notify women that there are certain services or information that they will not provide. This prevents women from participating fully in their own medical decision-making. Not only are their rights compromised, their health may be harmed.
Crisis pregnancy centers (CPCs) are major perpetrators of refusals to provide women with complete and accurate care and information. CPCs often pose as comprehensive health clinics or advertise in ways that imply they offer the full range of reproductive health care. Yet most CPCs will not provide accurate or complete information about birth control or abortion, and will not refer pregnant women to another provider who will. Their primary goal is to dissuade pregnant women from having an abortion, often by providing anti-abortion propaganda and misinformation about birth control and abortion. These deceptive practices undermine a woman’s ability to make an informed decision about her pregnancy and may delay her access to critical health services.
Relying on the legal tools that have long fostered transparency and stemmed deception in health care practices, local officials have passed ordinances to stop CPCs from falsely advertising and misleading women about the nature of their services. The ordinances intended to regulate CPCs are part of a long tradition of disclosure laws that enhance transparency and informed engagement in the healthcare arena. Moreover, the growing subset of disclosure laws governing reproductive healthcare reflect legislators’ awareness of time sensitive and critical nature of the services at issue. These laws traditionally operate by requiring that hospitals, pharmacies, insurance companies, and entities presenting themselves as health-care related disclose the nature of their services and relevant restrictions on patient care.
While CPCs allege that such ordinances, when applied to them, violate their First Amendment right to free speech, the challenged disclosure laws are part of the legal balance that local governments have struck to protect the needs of women and ensure that they receive complete information about their health care options. CPC disclosure laws simply seek to ensure that women are able to make informed health care decisions and know what type of services they can actually expect to receive at a CPC.
Women Expect to Receive Comprehensive Care, Not Refusals, Restrictions, or False Information
Women seeking health care information and services expect to receive comprehensive care, including counseling, options, and referrals. This is particularly true in the modern health care system, which has recognized the importance of treating patients as full participants in their care. Moreover, there has been a push – encouraged by health care providers and government officials – for improved communication and transparency between the health care industry and the individuals it serves. Because of this patient-centered focus, individuals seeking health care expect to be given all of the information and treatment options relevant to their particular situation when they seek services.
All too often, however, individuals visit a provider or entity or sign up for a health care plan that restricts services and information. Unfortunately, because such restrictions conflict with patients’ expectations, individuals are largely unaware of them. They do not think to ask if any restrictions exist and might mistakenly believe they are receiving comprehensive information and services when they are unknowingly receiving incomplete knowledge regarding their health care. These patients might then make a life- or health-altering decision based on incomplete information. This is true for women facing an unexpected pregnancy who look to CPCs for help. Although most CPCs are not staffed by licensed medical providers, they often hold themselves out as health clinics, advertising services such as free pregnancy tests, ultrasounds, and counseling. In doing so, they take advantage of women’s expectations that they will be provided with complete and accurate information.
Disclosure Helps to Ensure Patients Remain Fully Informed Decisionmakers
Requirements on those providing health care information or services to disclose any gaps in information or care to potential patients are important methods by which an individual remains an active participant in his or her care. Disclosure requirements allow individuals to learn in advance of any restrictions or obstructions to full and complete information and care. This allows individuals to discuss with their doctor, employer, insurance plan, or the facility they are visiting how these restrictions might compromise their care. Disclosure allows individuals to make informed decisions about which providers, facilities, or plans best meet their needs or fit their own values. Disclosure requirements are even more critical at locations, such as crisis pregnancy centers, where any member of the public can seek a service without a prior referral from someone who is aware of the kinds of restrictions that could exist.
Disclosure is Especially Critical for Women Seeking Reproductive Health Services
Disclosure is always important for any individual seeking health care services or information, but it is particularly critical to women seeking reproductive health care. That is because reproductive health care is an area where restrictions on information and services have proliferated and are permitted by law in particular circumstances.
Moreover, because of the time sensitivity of reproductive health care services, a delay in access caused by a lack of information or awareness of restrictions can result in serious harm. For example, early prenatal care helps the woman and health care provider monitor the pregnancy and identify any potential health problems before they become serious. Treatment for miscarriages and ectopic pregnancies is time sensitive. Proper contraceptive use relies on receiving accurate information and counseling, and timely access is especially critical for emergency contraception, which only works if taken within a specific time period after unprotected sex. And although abortion is an extremely safe procedure, any delay in access can make it less safe. When CPCs mislead women or deceive them into thinking they have received comprehensive care when they have not, they delay women’s access to these medically necessary reproductive health services.
Lawmakers Routinely Require Individuals and Entities to Disclose Refusals and Restrictions in Access to Reproductive Health Care
Because of the important role notice plays in ensuring that timely access to reproductive health care is not compromised, the federal government, states, and localities have established laws and regulations that require various disclosures to individuals seeking reproductive health care. These laws and regulations affirmatively require either that women be informed of reproductive health care options or that they receive notice that restrictions on information or services exist. Local laws requiring disclosure by CPCs fit squarely in this framework.
Laws Requiring that Women be Informed of Reproductive Health Care Options
Recognizing how important it is that women be informed of all of their reproductive health care options, Congress and state lawmakers have passed laws requiring disclosure of such information. For example,
- The federal Title X family planning program, which was enacted by Congress in 1970, requires Title X providers to “offer pregnant women the opportunity to be provided information and counseling regarding each of the following options: (A) Prenatal care and delivery; (B) Infant care, foster care, or adoption; and (C) Pregnancy termination.” If the woman requests such information and counseling, the provider must “provide neutral, factual information on each of the options, and referral upon request.”
- State lawmakers passed laws to ensure that a woman who has been sexually assaulted receives information about emergency contraception, which can prevent pregnancy after sexual assault. Fifteen states and the District of Columbia require emergency rooms to provide information about emergency contraception to sexual assault survivors, without exception. As the Colorado legislature explained in its law, “Because emergency contraception is time-sensitive and a sexual assault survivor may have delayed seeking hospital treatment, it is critical that she be informed of this option at the time of her treatment.”
Laws Requiring that Women be Informed of Restrictions on Reproductive Health Care Information and Services
Certain individual and institutional health care providers, as well as health related entities, such as insurance companies, are sometimes allowed by state or federal law to refuse to provide certain reproductive health services, usually because of religious beliefs. Recognizing the need to protect patients who seek access to reproductive health care information and services, some federal and state laws require that the refusing providers and entities provide disclosure and notice of restrictions to potential and existing patients. For example:
- Federal Medicaid law allows managed care plans that serve Medicaid patients to refuse to “provide, reimburse for, or provide coverage of, a counseling or referral service” if the organization objects on moral or religious grounds. However, in the case of such an objection, the state or its contracted representative must provide information about where and how to obtain the service to all potential enrollees before and during enrollment, and current enrollees must be notified of their right to request information about the scope of benefits as well as the “extent to which, and how, enrollees may obtain benefits, including family planning services, from out-of network providers.”
- Fifteen of the states that allow health care providers, institutions, or other entities to refuse to play a role in abortion, sterilization, contraception, or other reproductive health care services require disclosure to patients or potential patients of the refusal. For example, Louisiana requires individuals to “notify any patient before such person provides any consultation or service to the patient of the existence of a health care service that he will decline to provide because the health care service violates his conscience.”
- Over half of states have laws that require insurance policies issued in those states to cover prescription contraceptives if they cover other prescription drugs and devices, some of which exempt religious employers. In the vast majority of those that do, the religious entity is required to provide notice to potential and/or current enrollees or employees of its refusal to cover contraception. One state – Missouri – requires all plans to provide notice to enrollees about whether or not contraception is included and that enrollees who are members of a plan without coverage have “the right to purchase coverage for contraceptives.”
- In three states that require coverage of infertility services, any plans without coverage of these services due to a religious employer exemption must disclose the restrictions on coverage to enrollees or potential enrollees.
- Lawmakers have required disclosures in pharmacies, letting consumers know if they will not be able to access emergency contraception there. A New York City councilmember explained that the legislation was necessary “so women, if they are ever in the position where they need emergency contraception, which must be taken in a very time sensitive, 72 hours after unprotected intercourse, they would know where, close to their home, they could or could not access it.”
- California has a disclosure law aimed at informing individuals about the potential for restrictions on information or services in reproductive health care. It requires health insurers to inform enrollees that providers may refuse to provide certain reproductive health services. The law also identifies the location, language, and typeface of the notice.
Courts and State Attorneys General Also Have Required Entities – including CPCs – to Disclose Restrictions on Access to Reproductive Health Care Information and Services
In addition to laws and regulations requiring disclosure, courts and state attorneys general have also required entities – including CPCs – to disclose existing restrictions on reproductive health care information and services.
- The New York Attorney General conditioned the purchase of the nonsectarian Smithtown Campus hospital facilities to Catholic Health Services of Long Island (CHS) on CHS’s agreement to: (1) “notify doctors, patients, health plans in which Smith Hospital is a participating provider, and the general public that the sale . . . will reduce the availability of certain reproductive health care services at Smithtown Hospital”; and (2) provide a toll-free hotline for at least 6 months from the date that CHS takes over “to inform patients of the specific services that may be reduced or eliminated from Hospital operations and alternate health care providers, including hospitals, where those services remain available.”
- In an agreement reached between the New York Attorney General and a CPC in 2002, the center agreed to: “disclos[e] verbally and in writing – before providing a pregnancy test or counseling about pregnancy – that the center is not a licensed medical provider qualified to diagnose or accurately date pregnancy, and inform[] women that only licensed medical providers can confirm pregnancy or provide medical advice about pregnancy”; tell “persons who call or visit the center that it is not a medical facility”; and clearly inform “persons who inquire about abortion or birth control that it does not provide those services or make referrals for them.”
- A settlement between a CPC in New York and the state attorney general required, among other things, that the center disclose in its first contact with clients either in person or by telephone – if the client poses a question about abortion services – that the center does not perform abortions nor refer to abortion providers.
- A court in California issued an order that, among other things, required a CPC to disclose over the telephone that it did not perform or refer for abortion, provide birth control services or referrals, or provide written pregnancy verifications, and that the center “provides only alternatives to abortion counseling from a Biblical perspective by volunteers.”
Conclusion
CPCs have a documented history of imitating health clinics, falsely posing as abortion-providers, and purposely leading women away from full-service medical practitioners. It would be inconsistent with lawmakers’ and officials’ efforts to require disclosure in order to protect public health, ensure transparency, and protect patient decision making to allow CPCs to engage in deceptive and misleading practices that keep women from being able to make informed and timely health care decisions.
