For years — even before the Supreme Court overturned Roe v. Wade and abortion clinics shuttered across the country — Democratic state legislators have attempted to regulate crisis pregnancy centers.
They’ve largely failed.
A series of legal rulings and law enforcement decisions have effectively neutered state laws that had sought to take on so-called CPCs, which reproductive health rights groups say spread misinformation and misrepresent themselves to vulnerable women in search of resources, including abortion care.
But blue states remain determined to rein in the controversial centers, which people are even more reliant upon since the fall of Roe, and they're attempting to do so with a much more targeted approach.
Reproductive rights advocates are lauding some of these novel, nuanced strategies — while continuing to lament the broader landscape that has largely left them unable to curb what they say are ubiquitous deceptive practices.
“Lawmakers want to find solutions that don’t violate CPC rights, but that do protect patient rights. It’s really, really challenging, so you see different places going at it differently,” said Callie Wells, a policy counsel at Planned Parenthood.
“But it’s been a long time since a provision limiting or regulating a CPC has been upheld,” she said, adding that for years, “we haven’t seen too much success from the state legislative route.”
A roadblock from the Supreme Court
More than 2,500 crisis pregnancy centers operate in the country, outnumbering abortion clinics nearly 3 to 1 by some estimates. Critics, as well as supporters, have said the number of women seeking support at them has grown quickly in the 11 months since federal abortion rights were overturned, which resulted in the closing of abortion clinics in dozens of states.
In their absence, CPCs have continued to proliferate. While some provide free services and counseling for women with unplanned pregnancies, many have been found to provide women with misinformation designed to convince them to keep their pregnancy. For example, when two NBC News producers visited state-funded CPCs in Texas last year to ask for counseling, they were told that abortions caused mental illness and implied abortions could also cause cancer and infertility.
Those experiences aren’t uncommon: Nonpartisan medical experts have long documented how such centers dole out “misleading or false” information meant to discourage or prevent women from receiving abortion care.
Democratic lawmakers have for years attempted to regulate CPCs — many of which are faith-based and receive funding from religious groups, though many also get taxpayer dollars — but they’ve run into major roadblocks that have prevented them from enforcing such legislation.
Those struggles stem from a 2018 Supreme Court case that effectively rendered void what had at the time been the most comprehensive state effort to regulate CPCs.
Enacted by California Democrats, that law, called the Reproductive FACT Act, had required unlicensed CPCs to disclose they were not licensed medical facilities and required licensed ones that did not provide a comprehensive array of reproductive health care services to disclose that the state provided free or inexpensive care related to prenatal services, including abortion care. The policy, which supporters at the time touted as a “truth in advertising” law, had been constructed legally around targeting deceptive advertising practices.
But in a 5-4 majority ruling in the case, conservative justices sided with claims from such centers, which are frequently affiliated with religious or faith-based institutions, that the law likely violated their First Amendment rights because it forced them to make statements they said contradicted their beliefs.
The ruling largely silenced any meaningful state legislation designed to regulate such centers, until 2021, when Connecticut Democrats enacted a narrower law that prohibited deceptive advertising by CPCs, banning them — on their websites and in other marketing materials — from any efforts that made them appear like abortion care or comprehensive reproductive health care services providers.
But after a CPC sued over the law last year, the state’s Democratic attorney general disclosed in January that his office hadn’t taken any action against any such centers in the state, prompting the center to drop its case and publicize that it would continue to operate.
Those two instances essentially killed off any further enactment — even in blue states — of meaningful state legislation targeting CPCs, advocates said.
“At this point, the majority of those sort of impactful bills — that were aimed at limiting CPC disinformation or requiring disclosure of the services provided — have been watched by courts in a way that has had quite a chilling effect on other states,” Wells said. She added that some, however — including a 2011 San Francisco ordinance and a 2022 New York law — have remained unimpeded.
A fresh, hyper-targeted approach
Hampered by the broader legal landscape, Democratic state lawmakers have introduced or advanced at least 26 bills in their 2023 legislative sessions that seek to regulate CPCs in far more targeted ways, according to an NBC News review of state legislation related to the topic.
In Colorado, a law enacted last month regulates the administering of so-called abortion reversal pills — a cocktail of hormones some CPCs have dispensed, under the false claim that they can undo a medication abortion if taken at the right time.
The American College of Obstetricians and Gynecologists has slammed such pills as "not supported by science."
Colorado’s law classifies as “unprofessional conduct” any instance of an employee of a CPC — there are 51 in the state — administering such medication and subjects them to the subsequent “discipline” recommended by the relevant professional conduct state boards, which usually includes licensure penalties or suspensions.
The law also makes it a “deceptive trade practice” for CPCs to present themselves as venues that provide abortion care or emergency contraception.
In Minnesota, which awards nearly $3 million a year in funding to 90 centers across the state, Democrats have advanced legislation in both legislative chambers that would make that public funding contingent on those centers utilizing only medically accurate information.
And Democrats in New Jersey and Arizona have pitched bills that would require ultrasounds conducted at CPCs to be performed only by licensed physicians.
Such bills amount to “ways to go about making sure that CPCs are being held to higher standards … without necessarily targeting them with a consumer protection piece [of legislation], which falls in line with what was shut down by the Supreme Court,” said Ashley Underwood, the director of Equity Forward, a national group that conducts investigative research into CPCs.
Lawmakers wary of legal challenges in the mold of those made against the Connecticut and California laws have also — in New Jersey, California and other states — issued consumer alerts that serve to create awareness around many of the practices in question that CPCs use. Such alerts urge consumers to file complaints with certain state officials — in New Jersey, it’s the state Division of Consumer Affairs — but don’t offer any immediate enforcement or punitive measures.
Abortion opponents, for their part, continue to defend the centers, saying they’ve been unfairly targeted by Democrats in blue states.
“Pregnancy resource centers exist to help women in need by providing free pregnancy tests, ultrasounds, medical exams, counseling, parenting classes, financial classes; items such as food, diapers, and clothing; and financial assistance for housing and utilities,” Kelsey Pritchard, the director of state affairs for anti-abortion group Susan B. Anthony Pro-Life America, said in a statement.
“The twisted attempts to hinder pregnancy resource centers’ ability to serve women prove that Democrats in California, Illinois, Colorado and Minnesota are not pro-choice, they are pro-abortion,” Pritchard added.
Meanwhile, advocates acknowledged that even their targeted approaches, if enacted, are certain to face legal challenges — but they maintain it’s the right strategy for the moment.
“Essentially anything that states do, we accept that there will be litigation over it, if it is aimed at CPCs,” Wells said.
But, she added, “this is a harm that we want to talk about and we want to keep fighting against, and we’re not going to shy away from it.”