By: Henry A. Waxman, Committee on Government Reform Minority Office
Published: Jul 17, 2006
A new study released by Rep. Henry A. Waxman finds that federally funded pregnancy resource centers often mislead pregnant teens about the medical risks of abortion, telling investigators who posed as pregnant 17-year-olds that abortion leads to breast cancer, infertility, and mental illness.
Under the Bush Administration, pregnancy resource centers, which are also called "crisis pregnancy centers," have received over $30 million in federal funding. The new report assesses the scientific accuracy of the information they provide. Female investigators, who posed as pregnant 17-year-olds seeking advice about an unintended pregnancy, telephoned the 25 pregnancy resource centers that have received capacity-building funds from the Department of Health and Human Services.
Twenty of the 23 centers reached by the investigators (87%) provided false or misleading information about the health effects of abortion. According to the report:
* The centers provided false and misleading information about a link between abortion and breast cancer. There is a medical consensus that induced abortion does not cause an increased risk of breast cancer. Despite this consensus, eight centers told the caller that having an abortion would in fact increase her risk. One center said that "all abortion causes an increased risk of breast cancer in later years," while another told the caller that an abortion would "affect the milk developing in her breasts" and that the risk of breast cancer increased by as much as 80% following an abortion.
* The centers provided false and misleading information about the effect of abortion on future fertility. Abortions in the first trimester, using the most common abortion procedure, do not pose an increased risk of infertility. However, seven centers told the caller that having an abortion could hurt her chances of having children in the future. One center said that damage from abortion could lead to "many miscarriages" or to "permanent damage" so "you wouldn't be able to carry," telling the caller that this is "common" and happens "a lot."
* The centers provided false and misleading information about the mental health effects of abortion. Research shows that significant psychological stress after an abortion is no more common than after birth. However, thirteen centers told the caller that the psychological effects of abortion are severe, long-lasting, and common. One center said that the suicide rate in the year after an abortion "goes up by seven times." Another center said that post-abortion stress suffered by women having abortions is "much like" that seen in soldiers returning from Vietnam and "is something that anyone who's had an abortion is sure to suffer from."
In December 2004, Rep. Henry A. Waxman released a report analyzing the scientific accuracy of the curricula taught by federally funded abstinence-only education programs. That report found that the abstinence curricula often contained false or distorted information that misled teens about sex and reproductive health.
At the request of Rep. Waxman, this report examines the scientific accuracy of the information provided by another Bush Administration priority: federally funded "pregnancy resource centers." These organizations, which are also called "crisis pregnancy centers," provide counseling to pregnant teenagers and women. Since 2001, pregnancy resource centers have received over $30 million in federal funding. Most of this money has come from federal programs for abstinence-only education. Additional funding has been distributed as "capacity-building" grants to 25 pregnancy resource centers in 15 states as part of the new $150 million Compassion Capital Fund. Individual centers have also been the beneficiaries of earmarks in appropriations bills.
For this report, female investigators telephoned the 25 pregnancy resource centers that have received grants from the Compassion Capital Fund, requesting information and advice regarding an unintended pregnancy. Twenty-three of the centers were successfully contacted. In each call, the investigator posed as a pregnant 17-year-old trying to decide whether to have an abortion.
During the investigation, 20 of the 23 centers (87%) provided false or misleading information about the health effects of abortion. Often these federally funded centers grossly misrepresented the medical risks of abortion, telling the callers that having an abortion could increase the risk of breast cancer, result in sterility, and lead to suicide and "post-abortion stress disorder."
Specifically, the report finds:
The centers provided false and misleading information about a link between abortion and breast cancer. There is a medical consensus that induced abortion does not cause an increased risk of breast cancer. Despite this consensus, eight centers told the caller that having an abortion would in fact increase her risk. One center said that "all abortion causes an increased risk of breast cancer in later years." Another claimed that research shows a "far greater risk" of breast cancer after an abortion, telling the caller that an abortion would "affect the milk developing in her breasts" and that the risk of breast cancer increased by as much as 80% following an abortion.
The centers provided false and misleading information about the effect of abortion on future fertility. Abortions in the first trimester, using the most common abortion procedure, do not pose an increased risk for future fertility. However, seven centers told the caller that having an abortion could hurt her chances of having children in the future. One center said that damage from abortion could lead to "many miscarriages" or to "permanent damage" so "you wouldn't be able to carry," telling the caller that this is "common" and happens "a lot." Another center said, "In the future you could have trouble conceiving another baby" because of scar tissue, a side effect of abortion that happens to "a lot of women."
The centers provided false and misleading information about the mental health effects of abortion. Research shows that significant psychological stress after an abortion is no more common than after birth. However, thirteen centers told the caller that the psychological effects of abortion are severe, long-lasting, and common. One center said that the suicide rate in the year after an abortion "goes up by seven times." Another center said that post-abortion stress suffered by women having abortions is "much like" that seen in soldiers returning from Vietnam and "is something that anyone who's had an abortion is sure to suffer from." Other centers said that abortion can cause "guilt, sexual problems, suicidal ideas, drug use, eating disorders," and "a downward spiral where they lose friends and family members."
The individuals who contact federally funded pregnancy resource centers are often vulnerable teenagers, who are susceptible to being misled and need medically accurate information to help them make a fully informed decision. The vast majority of pregnancy resource centers contacted for this report, however, provided false or misleading information about the health risks of an abortion. This may advance the mission of the pregnancy resource centers, which are typically pro-life organizations dedicated to preventing abortion, but it is an inappropriate public health practice.
A. Pregnancy Resource Centers
"Pregnancy resource centers" are virtually always pro-life organizations whose goal is to persuade teenagers and women with unplanned pregnancies to choose motherhood or adoption. They do not offer abortions or referrals to abortion providers. In addition to initial counseling for pregnant teens and women, some centers may provide support services or referrals to prenatal care.
Many pregnancy resource centers, including all the centers contacted in this investigation, are affiliated with one or more national umbrella organizations. Two such networks are Heartbeat International and Care Net. Heartbeat International describes itself as the "first pro-life network of pregnancy resource centers in the U.S. and the largest in the world, supporting, strengthening and starting nearly 1,000 pregnancy centers to provide alternatives to abortion." Care Net describes itself as "a Christian ministry assisting and promoting the evangelistic, pro-life work of pregnancy centers in North America."
Many pregnancy resource centers used to describe themselves as "crisis pregnancy centers." One organization explained the change in terminology as follows: "God's truth never varies, but new methods of communicating it continue to emerge, including a departure from the term crisis pregnancy' itself. Many centers now favor a more neutral, solution-oriented name, such as pregnancy resource center.'"
Pregnancy resource centers often mask their pro-life mission in order to attract "abortion-vulnerable clients." This can take the form of advertising under "abortion services" in the yellow pages or obscuring the fact that the center does not provide referrals to abortions in the text of an advertisement. Some centers purchase advertising on internet search engines under keywords that include "abortion" or "abortion clinics." Other advertisements represent that the center will provide pregnant teenagers and women with an understanding of all of their options. For example, "Option Line," a joint venture of Heartbeat International and Care Net, is a 24-hour telephone hotline that connects pregnant teenagers and women with pregnancy resource centers in their communities. The main page of Option Line's website states at the top, "Pregnant? Need Help? You Have Options," but does not reveal that both Heartbeat International and Care Net represent only pro-life centers or that only non-abortion options will be counseled.
B. Federal Funding of Pregnancy Resource Centers
President Bush has declared that supporting pregnancy resource centers is a central component of his Administration's pro-life and faith-based agenda. In his acceptance speech at the 2000 Republican convention, Mr. Bush told the delegates:
Big government is not the answer, but the alternative to bureaucracy is not indifference. It is to put conservative values and conservative ideas into the thick of the fight for justice and opportunity. This is what I mean by compassionate conservatism, and on this ground, we will lead our nation. In the next bold step of welfare reform, we will support the heroic work of homeless shelters and hospices, food pantry and crisis pregnancy centers, people reclaiming their communities block by block and heart by heart.
The President has reiterated this theme in multiple speeches and proclamations:
"My Administration encourages adoption and supports abstinence education, crisis pregnancy programs, parental notification laws, and other measures to help us continue to build a culture of life."
"A generous society values all human life . and that is why my administration opposes partial-birth abortion and public funding for abortion; why we support teen abstinence and crisis pregnancy programs; adoption and parental notification laws; and why we are against all forms of human cloning."
"We will also continue our support for crisis pregnancy centers, incentives for adoption and parental notification laws. I propose to double federal funding for abstinence programs in schools and community-based programs."
Prior to the Bush Administration, only a few pregnancy resource centers received federal funding. Beginning in 2001, however, federal funding of pregnancy resource centers increased sharply. In total, over $30 million in federal funds went to more than 50 pregnancy resource centers between 2001 through 2005.
One major source of federal funds tapped by pregnancy resource centers is funding for abstinence-only education. Centers teach abstinence-until-marriage either on site or at other locations in the community, including public schools. At a 2005 conference, Care Net, the national umbrella organization, described the advantages of abstinence funding for pregnancy resource centers:
[D]efending and promoting a culture of life is not just about saving babies of those women that walk into the center that are pregnant and thinking about abortion . You're defending and promoting a culture of life through teaching them about their own sexuality, their own bodies, and in that, they begin to understand the creation process, and they begin to understand that an unborn child really is valuable. ...
Now obviously when you go into public schools you can't start talking about Jesus dying on the cross, or you may not get invited back very quickly. But you're opening the door to a lot more people that may not normally know of your center, you're building credibility for your pregnancy center, you're helping people begin to trust in your pregnancy center, so that if those girls that may have heard your story and didn't quite take it to heart and end up coming to your pregnancy center, or they have friends or family members that come, that trust is already built, and then you've already earned the right to be heard. So people that come into your center that have already heard you, you get the chance to share the Gospel with them, which is the ultimate thing of what we're doing.
At least 29 pregnancy resource centers received a total of over $24 million in Community-Based Abstinence Education (CBAE) funds from 2001 through 2005. Other pregnancy resource centers have received a total of at least $6 million in abstinence funding provided to the states under section 510 of Title V. The actual total may be higher because centralized information on these grants is not available. For many pregnancy resource centers receiving federal abstinence funding, the grants represented a major increase in their annual budget, in some cases expanding their budgets by seven-fold.
In other cases, pregnancy resource centers have received funding through
specific congressional earmarks, including for "counseling and pregnancy
For many pregnancy resource centers receiving federal abstinence funding, the
grants represented a major increase in their annual budget, in some cases
expanding their budgets by seven-fold.
Pregnancy resource centers have also received approximately $1 million through the "Compassion Capital Fund," a component of the Bush Administration's faith-based initiative. Created in 2002 and managed by the Administration for Children and Families at the Department of Health and Human Services, the Compassion Capital Fund was designed to bolster faith- and community-based organizations by providing technical assistance and "capacity building" grants. These grants allow recipients to "increase their effectiveness, enhance their ability to provide social services to serve those most in need, expand their organizations, diversify their funding sources, and create collaborations."
The Compassion Capital Fund, which has received $150 million in federal funds,
provides two types of financial support. "Demonstration grants" are
given to intermediary organizations that provide technical assistance and
subgrants to smaller faith-based and community groups. The fund also makes
"mini grants," one-time capacity-building awards of up to $50,000 for
faith-based and community organizations "to increase their capacity to
serve targeted social service priority areas."
To date, 25 pregnancy resource centers in 15 states have received grants through the Compassion Capital Fund. Twenty-two of these centers received an estimated total of $650,000 in subgrants from the Institute for Youth Development (IYD), an intermediary organization which focuses its subgrants on helping smaller organizations "build capacity to identify federal grant opportunities and to prepare highly competitive applications for federal assistance." Most of the IYD's subgrants to pregnancy resource centers have gone to recipients that are in the process of pursuing a "medical model" of service delivery, including those intending to pursue Medicaid reimbursement for their services.
Of the pregnancy resource centers that have received IYD subgrants, three applied for and received direct mini-grants from the Compassion Capital Fund. Three additional centers received mini-grants only. These six mini-grants totaled $293,000.
Two centers that received grants through the Compassion Capital Fund also received federal abstinence-only education funding worth $1.9 million.
II. PURPOSE AND METHODOLOGY
In December 2004, Rep. Waxman released a report by the Special Investigations Division that evaluated the scientific accuracy of the curricula used in federally funded abstinence-only education programs. The report found that nearly all of the curricula contained false, misleading, or distorted information about reproductive health. The curricula included inaccurate information about disease and pregnancy prevention; erroneous effectiveness rates for condoms; the presentation of religious belief as fact; and the teaching of stereotypes about boys and girls as science.
In this report, Rep. Waxman asked the Special Investigations Division to undertake a similar evaluation of federally funded pregnancy resource centers. Rep. Waxman requested that the investigation examine the medical accuracy of the information that these centers provide to pregnant teenagers seeking advice about whether to have an abortion. Rep. Waxman did not ask the Special Investigations Division to assess the merits of using federal funds to support organizations that provide pro-life counseling to pregnant teenagers and women, and this report does not address this issue.
In response to Rep. Waxman's request, the Special Investigation Division
identified the 25 pregnancy resource centers that have received grants through
the Compassion Capital Fund. For this report, female investigators telephoned
the 25 pregnancy resource centers that have received grants from the Compassion
Capital Fund, posing as a 17-year-old trying to decide whether to have an
abortion, and requesting information and advice. The caller stated that she was
pregnant and thought she wanted an abortion. If asked for more information, the
caller told center staff that:
she was 17;
she had taken a home pregnancy test and it was positive;
she had never been pregnant before;
her last menstrual period had fallen two months earlier; and
she wanted to receive as much information as possible on the phone because she didn't think she could come in to the center.
Calls were made to all 25 centers. A counselor was reached at 23 of the 25. Attempts made to reach the remaining two were unsuccessful.
Of the 25 centers, 20 maintain public websites. The Special Investigations Division also reviewed the medical accuracy of the information presented on these websites.
The vast majority of the federally funded pregnancy resource centers contacted during the investigation provided information about the risks of abortion that was false or misleading. In many cases, this information was grossly inaccurate or distorted. A pregnant teenager who relied on the information from these federally funded centers would make her decision about whether to give birth or terminate her pregnancy based on erroneous facts and misinformation.
In total, 87% of the centers reached (20 of 23 centers) provided false or misleading information to the callers. The three major areas of misinformation involved (1) the purported relationship between abortion and breast cancer; (2) the purported relationship between abortion and infertility; and (3) the purported relationship between abortion and mental illness.
A. Pregnancy Resource Centers Provided False and Misleading Information About Abortion and Breast Cancer
There is a medical consensus that there is no causal relationship between abortion and breast cancer. This consensus emerged after several well-designed studies, the largest of which was published in the New England Journal of Medicine in 1997, found no indication of increased risk of breast cancer following an induced abortion. In 2002, the Bush Administration edited a National Cancer Institute website to suggest that there was still an open scientific question about whether having an abortion might lead to breast cancer. After Rep. Waxman and other members of Congress protested the change, the National Cancer Institute convened a three-day conference of experts on abortion and breast cancer. Participants reviewed all existing population-based, clinical, and animal data available. Their conclusion was that "[i]nduced abortion is not associated with an increase in breast cancer risk." The panel ranked this conclusion as "[w]ell-established."
Despite this medical consensus, eight centers warned the caller that having an abortion would increase her risk of breast cancer. For example, one center told the caller that "all abortion causes an increased risk of breast cancer in later years." Another center said that research shows a "far greater risk" of breast cancer after an abortion.
Despite medical consensus that there is no causal link between abortion and
breast cancer, eight centers warned of such a link. One center claimed that the
risk would be "extremely high," increasing by as much as 80%.
A few centers provided a misleading explanation for the purported elevated risk. One told the caller that women who have abortions "are now finding out that they have breast cancer" because the development of hormones and glands in the breast tissue is abruptly stopped. Another center said that there is an increased risk of breast cancer because breast tissue is still developing when an abortion takes place. A third stated that terminating a pregnancy can "affect the milk forming in your breasts" and "some women are finding out that they're having breast cancer later on."
Several centers quantified the claimed risk. One center told the caller that there is an "extremely high, increased risk of breast cancer" that "can be as much as an 80% increase depending upon how the risk factors fall into place." A second center stated that abortion increases the risk of breast cancer by 50%. A third center asserted that an abortion elevates the average lifetime risk of breast cancer by 50% and that more abortions increase the risk even more.
The theme of abortion causing breast cancer is reflected in many of the centers' websites. One website reports an "[i]ncreased risk of breast cancer, particularly risky for those who abort their first pregnancy." It further states that "[w]hile study results vary, most demonstrate a 50% or greater increased risk." Another center website states: "For women aborting a first pregnancy, the risk of breast cancer almost doubles after a first-trimester abortion and is multiplied with two or more abortions. This risk is especially great for women who do not have children. Some recent studies have refuted this finding, but the majority of studies support a connection."
B. Pregnancy Resource Centers Provided False and Misleading Information About the Effect of Abortion on Future Fertility
Vacuum aspiration, the method most commonly used for abortions during the first trimester, does not pose an increased risk of infertility or other fertility problems. According to one authority:
Researchers have reviewed the world literature, including studies from 21 countries, and have concluded that women who have their first pregnancy terminated by vacuum aspiration are at no increased risk of subsequent infertility or ectopic pregnancy when compared with women who carry their first pregnancy to term. They also concluded that a single induced abortion performed by vacuum aspiration does not increase the risk of complications during future pregnancies, the risk of having a low birthweight baby, or the risk of having a pregnancy result in a miscarriage, stillbirth, infant death or congenital malformations.
During the investigation, the caller informed the pregnancy resource center that her last period had been approximately two months earlier and that this was a first pregnancy. These facts placed the caller in the category with no increased risk of infertility from vacuum aspiration. Nonetheless, seven pregnancy resource centers informed the caller that she would be at increased risk of fertility problems from abortion.
Several centers described the risk of abortion-induced infertility as common or high. One told the caller that damage from abortion could lead to "many miscarriages" or to "permanent damage" so "you wouldn't be able to carry." This center stated that this is "common" and happens "a lot."
One center told the caller that abortion "could destroy your chances of ever having children again" and that infertility "happens more often than the media reports."
Another center said, "In the future you could have trouble conceiving another baby" because of scar tissue. When the caller asked if that happens to a lot of women, the center said, "A lot of women, yeah." Another told the caller that if she did not need to have an abortion, she should not have one because "the risks of abortion are so great," involving damage to the cervix which could prevent pregnancy. A fourth center told the caller that abortion "could destroy your chances of ever having children again" and that infertility "happens more often than the media reports."
Other centers provided similarly misleading information:
One center said that there are "possibilities of miscarriage later on in life when you're wanting to get pregnant." When the caller asked if that happens a lot, the center responded, "I don't know what the full statistics are" but "it's just one of the possible risks."
Another center could not say "exactly how likely it is," but "a lot of the women we see here who've had abortions in the past" are not able to get pregnant.
Another center said that if the cervix is damaged, "it won't stay closed in future pregnancies, and it can open prematurely and you can have miscarriages." The center told the caller that these physical risks may not happen as often as the emotional risks of abortion, but "it is a very real possibility."
Several of the centers' websites contained the same type of misinformation. For example, one states that abortion brings an "[i]ncreased risk of infertility," claiming that 2% to 5% of abortions result in sterility." Another notes: "Infertility and sterility mean that a woman cannot get pregnant. Abortion causes sterility in 2-5% of the women who have an abortion."
C. Pregnancy Resource Centers Provided False and Misleading Information About the Mental Health Effects of Abortion
Pro-life advocates assert the existence of a condition called "Post-Abortion Syndrome," characterized as severe long-term emotional harm caused by abortion, and claim that this condition occurs frequently. Neither the American Psychological Association nor the American Psychiatric Association recognizes this syndrome, however. In fact, there is considerable scientific consensus that having an abortion rarely causes significant psychological harm. An expert panel of the American Psychological Association convened to "review the best scientific studies of abortion outcome" found:
The best studies available on psychological responses to unwanted pregnancy terminated by abortion in the United States suggest that severe negative reactions are rare, and they parallel those following other normal life stresses. Despite methodological shortcomings of individual studies, the fact that studies using diverse samples, different measures of postabortion response, and different times of assessment come to very similar conclusions is persuasive evidence that abortion is usually psychologically benign.
Other studies have reached similar results. A subsequent analysis based on a longitudinal study of women one hour before, one hour after, one month after, and two years after abortion found: "Reports support prior conclusions that severe psychological distress after an abortion is rare." A study based on data from the National Longitudinal Survey of Youth, with respondents initially aged 14 to 21, found: "Although women may experience some distress immediately after having an abortion, the experience has no independent effect on their psychological well-being over time." Similarly, a review of multiple studies of teens and abortion reported: "data do not suggest that legal minors are at heightened risk of serious adverse psychological responses compared with adult abortion patients or with peers who have not undergone abortion." Yet another longitudinal study followed 13,000 women in Britain over a period of 11 years and found that women who continued the pregnancy and gave birth experienced the same rate of need for psychological treatment as women who had abortions.
One center compared the effects of having an abortion to the experience of
soldiers returning from Vietnam, and said that post-abortion stress "is
something that anyone who's had an abortion is sure to suffer from."
Despite the scientific evidence that abortion does not cause significant long-term psychological harm, thirteen pregnancy resource centers told callers the exact opposite, asserting that having an abortion would cause a wide range of damaging and long-lasting psychological impacts.
According to one center, "the rate of suicide in the year following an abortion goes up by seven times." Other centers described lengthy lists of emotional harm that could result from an abortion:
One center said that abortion can bring "huge" emotional complications. The center said that emotions experienced by women following an abortion can be: "guilt, numbness, dreams and nightmares, changes in relationships, difficulty with making friends, sexual problems, preoccupation with abortion date or due date, sadness, anxiety, suicidal ideas, sedatives, alcohol, drug use, eating disorders, sense of loss, inability to relax, fear of failure, crying spells, regret, anger, helplessness, headaches, loneliness, panic, signs of marital stress.
Another warned of "sadness, long-term grief, anger, sexual dysfunction, guilt, flashbacks, memory repression, anniversary reaction, suicidal thoughts, increased use of alcohol or drugs, or difficulty maintaining close relationships."
A third center described flashbacks and a "downward spiral where they lose friends and family members."
Another center told the caller that "the side effects of abortion are pretty awful," including guilt or shame, depression, isolation, anxiety, anger, sadness, preoccupation with getting pregnant again, eating disorders, drugs or alcohol abuse, difficulty with intimate relationships, and suicidal thoughts, and "there is more after that." This center said that after an abortion, 80% of women seek psychiatric help "in relation to their abortion," often years later. In contrast, the center asserted that only 3% of women who have full-term pregnancies seek psychiatric care for short-lived post-partum depression, explaining:
Having a baby is a normal process and what it does is fulfills a woman. It is fulfilling one of the roles that she has. Abortion is the exact opposite; she is doing something totally contrary to what her role is. That's why it has such an emotional impact on women.
One center compared the experience of having an abortion to the experience of going to war, analogizing the post-traumatic stress experienced after an abortion to that seen in soldiers after Vietnam, and said that it "is something that anyone who's had an abortion is sure to suffer from."
The pregnancy resource centers indicated that these emotional effects are extremely common, telling the caller: over 75% of women experience mild to severe post-abortion stress syndrome ; "[j]ust about over 90% of women have some type of emotional or psychological effects of abortion" ; post-abortion syndrome and other problems happen to everyone "in varying degrees" ; and the "majority" of women who choose abortion have post abortion syndrome in "various degrees." The center that asserted that suicide rates increase seven times following an abortion also said that "60-70% of women have emotional complications from an abortion."
The idea that abortion is likely to lead to long-term psychological harm was also present on many of the centers' websites. For example, the following descriptions appeared on these websites:
"What is Post Abortion Syndrome? Nine out of every ten women who have undergone an abortion suffer deep seated anxiety and regret called post-abortion syndrome. Sometimes it appears many years later."
"Psychological/Emotional Trauma: 50% of post-abortive women report experiencing emotional and psychological disturbances lasting for months or years. This includes acute feeling of grief, depression, anger, fear of disclosure, preoccupation with babies or getting pregnant again, nightmares, sexual dysfunction, termination of relationships, emotional coldness, increased alcohol and drug abuse, eating disorders, anxiety, flashbacks, anniversary syndrome, repeat abortions, and suicide."
Pregnant teenagers and women turn to federally funded pregnancy resource centers for advice and counseling at a difficult time in their lives. These centers, however, frequently fail to provide medically accurate information. The vast majority of pregnancy centers contacted in this investigation misrepresented the medical consequences of abortion, often grossly exaggerating the risks. This tactic may be effective in frightening pregnant teenagers and women and discouraging abortion. But it denies the teenagers and women vital health information, prevents them from making an informed decision, and is not an accepted public health practice.