Analysis Abortion

How Deeply Flawed Studies on Abortion and Breast Cancer Become Anti-Choice Fodder

Joyce Arthur

Anti-choice advocates are using findings from a new study out of China to jump to the unwarranted conclusion that abortion causes an increased breast cancer risk. But the study’s methodology and data appear seriously flawed, with the results likely reflecting “recall bias.”

The anti-choice movement has been making a lot of noise over a new study out of China, published in the journal Cancer Causes & Control, that purports to show a 44 percent increase in breast cancer risk for women who have had an abortion, with the risk increasing after each subsequent abortion. The study claims this may help explain the “alarming” rise in breast cancer in China over the past 20 years, which parallels the one-child policy introduced in 1979.

But the study’s methodology and data appear seriously flawed, with the results likely reflecting “recall bias.” This would invalidate the study’s findings. Recall bias is a common hazard in case-control studies, which use questionnaires or interviews to gather historical data from participants. Results can be skewed or inaccurate because people have a tendency to forget past events, or neglect to mention them, especially if they are uncomfortable with sharing the information with researchers. For example, underreporting occurs when people are asked about substance use, criminal offenses, family background, or school performance.

Recall bias is even more of a problem when it comes to reporting reproductive history, especially past abortions. In the United States, only 47 percent of abortions were reported in the largest and most recent fertility survey (from 2002). A 1996 analysis cited numerous studies on the topic and found that, as a likely result of abortion stigma, women reported only 20 to 80 percent of their abortions. (The wide range is due to varying interview circumstances, geographic locations, or demographic characteristics of the women.) A significant body of evidence has accumulated on abortion underreporting, going back to the early days of legal abortion in 1960s eastern Europe, as documented by Christopher Tietze and Stanley K. Henshaw:

The classic example is the Fertility and Family Planning Study of 1966, conducted in Hungary a decade after the legalization of abortion. In that survey, the numbers of abortions reported by the respondents for the years 1960-65 corresponded to only 50-60 percent of the number actually performed. A comparable level of underreporting was also noted in 1977.

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But how does an apparent association arise between abortion and breast cancer (ABC)? In case-control studies on the topic, researchers select and divide women into two groups: women with breast cancer (the “cases”) and women without the disease (the “controls”). The women in both groups will then be asked whether they’ve had an abortion to see if the disease might be more commonly associated with that. However, cancer patients will be strongly motivated to remember and share their full medical history in the search for answers (this is called “rumination bias”), while women acting as controls in a study have no stake in the outcome and so are less likely to mention past abortions. They would be even less likely to report several past abortions because of the increased stigma. The result is a flawed study, because it will appear that women with breast cancer had more abortions than those in the control group, when they probably didn’t.

This “differential recall” is a known risk in case-control studies in general, although few studies have been done to show the effect in studies on the ABC association. A 1991 analysis in Sweden compared two studies: one that used women’s abortion records from a national registry, and a case-control study that relied on women self-reporting their abortions (that were also recorded in the registry). In the end, 27.1 percent of controls underreported past abortions, compared to 20.8 percent of cases (see Rookus/Leeuwen letter). Another study took place in the Netherlands in 1996 in which case and control groups were interviewed in different regions of the country. The correlation between induced abortion and breast cancer was very strong in regions of the country with a predominantly Roman Catholic population, but much weaker in regions with less abortion stigma. Although the sample size of women who had abortions was small in the Catholic regions, a large number of women in those areas also underreported contraceptive use to a greater extent than in more liberal regions.

Anti-choice activist Dr. Joel Brind has been promoting the ABC association for over two decades. He claims that the Chinese study “neutralized” the recall bias argument. But Brind missed—or chose not to mention—that the journal article contained a confusing error, one that helped to hide the study’s own recall bias shortcomings. Early on, the study authors say:

The lack of a social stigma associated with induced abortion in China may limit the amount of underreporting.

But later in the study, the authors say:

[T]he self-reported number of IA [induced abortions] will probably be underestimated, as the stigma of abortion still exists in China, especially when a woman has more than two IAs. Therefore, this underestimation will inevitably create spurious associations between IA and breast cancer, especially for more IAs.

These two contradictory statements should never have gotten past the peer reviewers.

Regardless of whether abortion is stigmatized in China and to what degree, abortion is still underreported even in countries where abortion is more widely accepted, such as Estonia and Hungary. But the study authors are probably right in their second statement: Abortion stigma does exist in China. An increasing number of young unmarried women are having abortions—often multiple abortions—but there is a stigma in China against premarital sex and an even bigger stigma against out-of-wedlock pregnancies. In these circumstances, it would be very surprising indeed if young Chinese women were not underreporting their abortions. Further, since the study authors admit that abortion stigma in China is more pronounced for subsequent abortions, this would explain the rising association that the authors found between multiple abortions and breast cancer—because women in control groups would be increasingly less likely to report their second or third abortions.

Another type of study, called a “cohort study,” is considered more reliable than case-control studies. In a typical cohort study, researchers spend many years following large numbers of women, some of whom have had abortions, to see which ones develop breast cancer later. Recall bias is not an issue because abortion data is drawn from public records. The result is an accurate percentage of how many women got breast cancer compared to others who didn’t have abortions. Out of at least nine cohort studies done since 1996, not one has found a statistically significant association between abortion and breast cancer, and some found negative associations—meaning abortion might actually protect against breast cancer.

The Chinese study was not a cohort study or even a case-control study. It was a meta-analysis, which combines the results of numerous studies on the same topic to come up with a pooled average. The authors found 36 previous Chinese studies on the ABC association and combined their results to come up with an “odds ratio” of 1.44, which means a 44 percent increased risk of breast cancer for women who had one abortion. However, the authors used 34 case-control studies and only two cohort studies (not included in the nine mentioned above). Neither cohort study showed a statistically significant ABC association. Further, six of the case-control studies that were rated as having the highest quality methodology, according to the authors’ own evaluation, also showed no correlation. In other words, the supposed ABC association arose solely from the weakest 26 studies selected for the meta-analysis, some of which were not even published in peer-reviewed journals.

The major weakness of meta-analyses has a popular acronym—GIGO. It means “garbage in, garbage out.” In other words, if most of the studies you add to the mix are seriously flawed, your pooled result will be worthless as well. To their credit, the study’s authors make clear that induced abortion is not confirmed as a causal risk factor for breast cancer and that their own results should be interpreted with caution. In fact, the scientific community has already dismissed abortion as a risk factor based on the best studies. Given that the correlation only shows up in case-control studies but never cohort studies, it’s highly likely to be an artifact of recall bias.

Although correlation does not equal causation, anti-choice advocates are using the Chinese study to jump to the unwarranted conclusion that abortion causes an increased breast cancer risk. Unfortunately, the study authors never mention other possible risk factors that could help explain the recent rise in breast cancer in China, let alone why they should be rejected in favor of abortion. These include:

  • Fewer full-term pregnancies (one or two) because of the one-child policy;
  • Economic development leading to more affluence and rising body weight (as found in one of the two Chinese cohort studies);
  • Increased industrialization and dramatically increased exposure to environmental toxins in a country with few environmental controls; and
  • Improved protocols for cancer testing, leading to more diagnoses of breast cancer.

Because the study focuses only on China, it also obscures the lack of association between breast cancer and abortion in many other countries. For example, western Europe has low abortion rates and high breast cancer rates, while Russia has high abortion rates and moderate breast cancer rates. It is unreasonable to assume the existence of an ABC association when it’s found inconsistently and depends more on geography or study methodology. Further, if there really were a causal connection, it would show up more robustly across most studies, instead of being all over the map.

The study’s ABC association was quite weak in comparison to major risk factors for breast cancer, such as advanced age, having a family history of breast cancer, or being childless. In a specific population such as women in China, weak associations can turn up by chance, and are therefore random and meaningless. For example, if you compared the population of storks with the rates of childbirth outside hospitals in various countries, a correlation will appear in some of them. It does not mean that storks deliver babies in some countries but not in others. It just means that you can find a correlation between almost anything if you’re determined to find it.

The promotion of flawed studies to try to prove that abortion leads to breast cancer is a political effort spearheaded by anti-choice groups and individuals, who primarily use these studies to reinforce abortion stigma and frighten women. The studies may also be a vehicle to smuggle in dogmatic beliefs under the guise of objectivity and the scientific method. As such, they irresponsibly advance an anti-choice agenda at the expense of science and women’s welfare.

Stanley Henshaw and Dr. Christian Fiala supported the author in writing this article.

News Abortion

Texas Pro-Choice Advocates Push Back Against State’s Anti-Choice Pamphlet

Teddy Wilson

The “A Woman’s Right to Know” pamphlet, published by the state, has not been updated since 2003. The pamphlet includes the medically dubious link between abortion care and breast cancer, among other medical inaccuracies common in anti-choice literature.

Reproductive rights advocates are calling for changes to information forced on pregnant people seeking abortion services, thanks to a Texas mandate.

Texas lawmakers passed the Texas Woman’s Right to Know Act in 2003, which requires abortion providers to inform pregnant people of the medical risks associated with abortion care, as well as the probable gestational age of the fetus and the medical risks of carrying a pregnancy to term.

The “A Woman’s Right to Know” pamphlet, published by the state, has not been updated or revised since it was first made public in 2003. The pamphlet includes the medically dubious link between abortion care and breast cancer, among other medical inaccuracies common in anti-choice literature. 

The Texas Department of State Health Services (DSHS) in June published a revised draft version of the pamphlet. The draft version of “A Woman’s Right to Know” was published online, and proposed revisions are available for public comment until Friday.

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John Seago, spokesperson for the anti-choice Texas Right to Life, told KUT that the pamphlet was created so pregnant people have accurate information before they consent to receiving abortion care.

“This is a booklet that’s not going to be put in the hands of experts, it’s not going to be put in the hands of OB-GYNs or scientists–it’s going to be put in the hands of women who will range in education, will range in background, and we want this booklet to be user-friendly enough that anyone can read this booklet and be informed,” he said.

Reproductive rights advocates charge that the information in the pamphlet presented an anti-abortion bias and includes factually incorrect information.

More than 34 percent of the information found in the previous version of the state’s “A Woman’s Right to Know” pamphlet was medically inaccurate, according to a study by a Rutgers University research team.

State lawmakers and activists held a press conference Wednesday outside the DSHS offices in Austin and delivered nearly 5,000 Texans’ comments to the agency.  

Kryston Skinner, an organizer with the Texas Equal Access Fund, spoke during the press conference about her experience having an abortion in Texas, and how the state-mandated pamphlet made her feel stigmatized.

Skinner told Rewire that the pamphlet “causes fear” in pregnant people who are unaware that the pamphlet is rife with misinformation. “It’s obviously a deterrent,” Skinner said. “There is no other reason for the state to force a medical professional to provide misinformation to their patients.”

State Rep. Donna Howard (D-Austin) said in a statement that the pamphlet is the “latest shameful example” of Texas lawmakers playing politics with reproductive health care. “As a former registered nurse, I find it outrageous that the state requires health professionals to provide misleading and coercive information to patients,” Howard said.

Howard, vice chair of the Texas House Women’s Health Caucus, vowed to propose legislation that would rid the booklet of its many inaccuracies if DSHS fails to take the thousands of comments into account, according to the Austin Chronicle

Lawmakers in several states have passed laws mandating that states provide written materials to pregnant people seeking abortion services. These so-called informed consent laws often require that the material include inaccurate or misleading information pushed by legislators and organizations that oppose legal abortion care. 

The American Congress of Obstetricians and Gynecologists (ACOG) sent a letter to DSHS that said the organization has “significant concerns with some of the material and how it is presented.”

Among the most controversial statements made in the pamphlet is the claim that “doctors and scientists are actively studying the complex biology of breast cancer to understand whether abortion may affect the risk of breast cancer.”

Texas Right to Life said in a statement that the organization wants the DSHS include “stronger language” about the supposed correlation between abortion and breast cancer. The organization wants the pamphlet to explicitly cite “the numerous studies that indicate undergoing an elective abortion contributes to the incidence of breast cancer in women.”

Rep. Sarah Davis (R-West University Place) said in a statement that the state should provide the “most accurate science available” to pregnant people seeking an abortion. “As a breast cancer survivor, I am disappointed that DSHS has published revisions to the ‘A Woman’s Right to Know’ booklet that remain scientifically and medically inaccurate,” Davis said.

The link between abortion and cancer has been repeatedly debunked by scientific research.

“Scientific research studies have not found a cause-and-effect relationship between abortion and breast cancer,” according to the American Cancer Society.

A report by the National Cancer Institute explains, “having an abortion or miscarriage does not increase a woman’s subsequent risk of developing breast cancer.”

DSHS spokesperson Carrie Williams told the Texas Tribune that the original booklet was written by a group of agency officials, legislators and public health and medical professionals.

“We carefully considered medical and scientific information when updating the draft booklet,” Williams said.

Analysis Abortion

‘Pro-Life’ Pence Transfers Money Intended for Vulnerable Households to Anti-Choice Crisis Pregnancy Centers

Jenn Stanley

Donald Trump's running mate has said that "life is winning in Indiana"—and the biggest winner is probably a chain of crisis pregnancy centers that landed a $3.5 million contract in funds originally intended for poor Hoosiers.

Much has been made of Republican Gov. Mike Pence’s record on LGBTQ issues. In 2000, when he was running for U.S. representative, Pence wrote that “Congress should oppose any effort to recognize homosexual’s [sic] as a ‘discreet and insular minority’ [sic] entitled to the protection of anti-discrimination laws similar to those extended to women and ethnic minorities.” He also said that funds meant to help people living with HIV or AIDS should no longer be given to organizations that provide HIV prevention services because they “celebrate and encourage” homosexual activity. Instead, he proposed redirecting those funds to anti-LGBTQ “conversion therapy” programs, which have been widely discredited by the medical community as being ineffective and dangerous.

Under Pence, ideology has replaced evidence in many areas of public life. In fact, Republican presidential nominee Donald Trump has just hired a running mate who, in the past year, has reallocated millions of dollars in public funds intended to provide food and health care for needy families to anti-choice crisis pregnancy centers.

Gov. Pence, who declined multiple requests for an interview with Rewire, has been outspoken about his anti-choice agenda. Currently, Indiana law requires people seeking abortions to receive in-person “counseling” and written information from a physician or other health-care provider 18 hours before the abortion begins. And thanks, in part, to other restrictive laws making it more difficult for clinics to operate, there are currently six abortion providers in Indiana, and none in the northern part of the state. Only four of Indiana’s 92 counties have an abortion provider. All this means that many people in need of abortion care are forced to take significant time off work, arrange child care, and possibly pay for a place to stay overnight in order to obtain it.

This environment is why a contract quietly signed by Pence last fall with the crisis pregnancy center umbrella organization Real Alternatives is so potentially dangerous for Indiana residents seeking abortion: State-subsidized crisis pregnancy centers not only don’t provide abortion but seek to persuade people out of seeking abortion, thus limiting their options.

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“Indiana is committed to the health, safety, and wellbeing [sic] of Hoosier families, women, and children,” reads the first line of the contract between the Indiana State Department of Health and Real Alternatives. The contract, which began on October 1, 2015, allocates $3.5 million over the course of a year for Real Alternatives to use to fund crisis pregnancy centers throughout the state.

Where Funding Comes From

The money for the Real Alternatives contract comes from Indiana’s Temporary Assistance for Needy Families (TANF) block grant, a federally funded, state-run program meant to support the most vulnerable households with children. The program was created by the 1996 Personal Responsibility and Work Opportunity Reconciliation Act signed by former President Bill Clinton. It changed welfare from a federal program that gave money directly to needy families to one that gave money, and a lot of flexibility with how to use it, to the states.

This TANF block grant is supposed to provide low-income families a monthly cash stipend that can be used for rent, child care, and food. But states have wide discretion over these funds: In general, they must use the money to serve families with children, but they can also fund programs meant, for example, to promote marriage. They can also make changes to the requirements for fund eligibility.

As of 2012, to be eligible for cash assistance in Indiana, a household’s maximum monthly earnings could not exceed $377, the fourth-lowest level of qualification of all 50 states, according to a report by the Congressional Research Service. Indiana’s program also has some of the lowest maximum payouts to recipients in the country.

Part of this is due to a 2011 work requirement that stripped eligibility from many families. Under the new work requirement, a parent or caretaker receiving assistance needs to be “engaged in work once the State determines the parent or caretaker is ready to engage in work,” or after 24 months of receiving benefits. The maximum time allowed federally for a family to receive assistance is 60 months.

“There was a TANF policy change effective November 2011 that required an up-front job search to be completed at the point of application before we would proceed in authorizing TANF benefits,” Jim Gavin, a spokesman for the state’s Family and Social Services Administration (FSSA), told Rewire. “Most [applicants] did not complete the required job search and thus applications were denied.”

Unspent money from the block grant can be carried over to following years. Indiana receives an annual block grant of $206,799,109, but the state hasn’t been using all of it thanks to those low payouts and strict eligibility requirements. The budget for the Real Alternatives contract comes from these carry-over funds.

According to the U.S. Department of Health and Human Services, TANF is explicitly meant to clothe and feed children, or to create programs that help prevent “non-marital childbearing,” and Indiana’s contract with Real Alternatives does neither. The contract stipulates that Real Alternatives and its subcontractors must “actively promote childbirth instead of abortion.” The funds, the contract says, cannot be used for organizations that will refer clients to abortion providers or promote contraceptives as a way to avoid unplanned pregnancies and sexually transmitted infections.

Parties involved in the contract defended it to Rewire by saying they provide material goods to expecting and new parents, but Rewire obtained documents that showed a much different reality.

Real Alternatives is an anti-choice organization run by Kevin Bagatta, a Pennsylvania lawyer who has no known professional experience with medical or mental health services. It helps open, finance, and refer clients to crisis pregnancy centers. The program started in Pennsylvania, where it received a $30 million, five-year grant to support a network of 40 subcontracting crisis pregnancy centers. Auditor General Eugene DePasquale called for an audit of the organization between June 2012 and June 2015 after hearing reports of mismanaged funds, and found $485,000 in inappropriate billing. According to the audit, Real Alternatives would not permit DHS to review how the organization used those funds. However, the Pittsburgh Post-Gazette reported in April that at least some of the money appears to have been designated for programs outside the state.

Real Alternatives also received an $800,000 contract in Michigan, which inspired Gov. Pence to fund a $1 million yearlong pilot program in northern Indiana in the fall of 2014.

“The widespread success [of the pilot program] and large demand for these services led to the statewide expansion of the program,” reads the current $3.5 million contract. It is unclear what measures the state used to define “success.”

 

“Every Other Baby … Starts With Women’s Care Center”

Real Alternatives has 18 subcontracting centers in Indiana; 15 of them are owned by Women’s Care Center, a chain of crisis pregnancy centers. According to its website, Women’s Care Center serves 25,000 women annually in 23 centers throughout Florida, Illinois, Indiana, Michigan, Minnesota, Ohio, and Wisconsin.

Women’s Care Centers in Indiana received 18 percent of their operating budget from state’s Real Alternatives program during the pilot year, October 1, 2014 through September 30, 2015, which were mostly reimbursements for counseling and classes throughout pregnancy, rather than goods and services for new parents.

In fact, instead of the dispensation of diapers and food, “the primary purpose of the [Real Alternatives] program is to provide core services consisting of information, sharing education, and counseling that promotes childbirth and assists pregnant women in their decision regarding adoption or parenting,” the most recent contract reads.

The program’s reimbursement system prioritizes these anti-choice classes and counseling sessions: The more they bill for, the more likely they are to get more funding and thus open more clinics.

“This performance driven [sic] reimbursement system rewards vendor service providers who take their program reimbursement and reinvest in their services by opening more centers and hiring more counselors to serve more women in need,” reads the contract.

Classes, which are billed as chastity classes, parenting classes, pregnancy classes, and childbirth classes, are reimbursed at $21.80 per client. Meanwhile, as per the most recent contract, counseling sessions, which are separate from the classes, are reimbursed by the state at minimum rates of $1.09 per minute.

Jenny Hunsberger, vice president of Women’s Care Center, told Rewire that half of all pregnant women in Elkhart, LaPorte, Marshall, and St. Joseph Counties, and one in four pregnant women in Allen County, are clients of their centers. To receive any material goods, such as diapers, food, and clothing, she said, all clients must receive this counseling, at no cost to them. Such counseling is billed by the minute for reimbursement.

“When every other baby born [in those counties] starts with Women’s Care Center, that’s a lot of minutes,” Hunsberger told Rewire.

Rewire was unable to verify exactly what is said in those counseling sessions, except that they are meant to encourage clients to carry their pregnancies to term and to help them decide between adoption or child rearing, according to Hunsberger. As mandated by the contract, both counseling and classes must “provide abstinence education as the best and only method of avoiding unplanned pregnancies and sexually transmitted infections.”

In the first quarter of the new contract alone, Women’s Care Center billed Real Alternatives and, in turn, the state, $239,290.97; about $150,000 of that was for counseling, according to documents obtained by Rewire. In contrast, goods like food, diapers, and other essentials for new parents made up only about 18.5 percent of Women’s Care Center’s first-quarter reimbursements.

Despite the fact that the state is paying for counseling at Women’s Care Center, Rewire was unable to find any licensing for counselors affiliated with the centers. Hunsberger told Rewire that counseling assistants and counselors complete a minimum training of 200 hours overseen by a master’s level counselor, but the counselors and assistants do not all have social work or psychology degrees. Hunsberger wrote in an email to Rewire that “a typical Women’s Care Center is staffed with one or more highly skilled counselors, MSW or equivalent.”

Rewire followed up for more information regarding what “typical” or “equivalent” meant, but Hunsberger declined to answer. A search for licenses for the known counselors at Women’s Care Center’s Indiana locations turned up nothing. The Indiana State Department of Health told Rewire that it does not monitor or regulate the staff at Real Alternatives’ subcontractors, and both Women’s Care Center and Real Alternatives were uncooperative when asked for more information regarding their counseling staff and training.

Bethany Christian Services and Heartline Pregnancy Center, Real Alternatives’ other Indiana subcontractors, billed the program $380.41 and $404.39 respectively in the first quarter. They billed only for counseling sessions, and not goods or classes.

In a 2011 interview with Philadelphia City Paper, Kevin Bagatta said that Real Alternatives counselors were not required to have a degree.

“We don’t provide medical services. We provide human services,” Bagatta told the City Paper.

There are pregnancy centers in Indiana that provide a full range of referrals for reproductive health care, including for STI testing and abortion. However, they are not eligible for reimbursement under the Real Alternatives contract because they do not maintain an anti-choice mission.

Parker Dockray is the executive director of Backline, an all-options pregnancy resource center. She told Rewire that Backline serves hundreds of Indiana residents each month, and is overwhelmed by demand for diapers and other goods, but it is ineligible for the funding because it will refer women to abortion providers if they choose not to carry a pregnancy to term.

“At a time when so many Hoosier families are struggling to make ends meet, it is irresponsible for the state to divert funds intended to support low-income women and children and give it to organizations that provide biased pregnancy counseling,” Dockray told Rewire. “We wish that Indiana would use this funding to truly support families by providing job training, child care, and other safety net services, rather than using it to promote an anti-abortion agenda.”

“Life Is Winning in Indiana”

Time and again, Bagatta and Hunsberger stressed to Rewire that their organizations do not employ deceitful tactics to get women in the door and to convince them not to have abortions. However, multiple studies have proven that crisis pregnancy centers often lie to women from the moment they search online for an abortion provider through the end of their appointments inside the center.

These studies have also shown that publicly funded crisis pregnancy centers dispense medically inaccurate information to clients. In addition to spreading lies like abortion causing infertility or breast cancer, they are known to give false hopes of miscarriages to people who are pregnant and don’t want to be. A 2015 report by NARAL Pro-Choice America found this practice to be ubiquitous in centers throughout the United States, and Rewire found that Women’s Care Center is no exception. The organization’s website says that as many as 40 percent of pregnancies end in natural miscarriage. While early pregnancy loss is common, it occurs in about 10 percent of known pregnancies, according to the American Congress of Obstetricians and Gynecologists.

Crisis pregnancy centers also tend to crop up next to abortion clinics with flashy, deceitful signs that lead many to mistakenly walk into the wrong building. Once inside, clients are encouraged not to have an abortion.

A Google search for “abortion” and “Indianapolis” turns up an ad for the Women’s Care Center as the first result. It reads: “Abortion – Indianapolis – Free Ultrasound before Abortion. Located on 86th and Georgetown. We’re Here to Help – Call Us Today: Abortion, Ultrasound, Locations, Pregnancy.”

Hunsberger denies any deceit on the part of Women’s Care Center.

“Clients who walk in the wrong door are informed that we are not the abortion clinic and that we do not provide abortions,” Hunsberger told Rewire. “Often a woman will choose to stay or return because we provide services that she feels will help her make the best decision for her, including free medical-grade pregnancy tests and ultrasounds which help determine viability and gestational age.”

Planned Parenthood of Indiana and Kentucky told Rewire that since Women’s Care Center opened on 86th and Georgetown in Indianapolis, many patients looking for its Georgetown Health Center have walked through the “wrong door.”

“We have had patients miss appointments because they went into their building and were kept there so long they missed their scheduled time,” Judi Morrison, vice president of marketing and education, told Rewire.

Sarah Bardol, director of Women’s Care Center’s Indianapolis clinic, told the Criterion Online Edition, a publication of the Archdiocese of Indianapolis, that the first day the center was open, a woman and her boyfriend did walk into the “wrong door” hoping to have an abortion.

“The staff of the new Women’s Care Center in Indianapolis, located just yards from the largest abortion provider in the state, hopes for many such ‘wrong-door’ incidents as they seek to help women choose life for their unborn babies,” reported the Criterion Online Edition.

If they submit to counseling, Hoosiers who walk into the “wrong door” and “choose life” can receive up to about $40 in goods over the course their pregnancy and the first year of that child’s life. Perhaps several years ago they may have been eligible for Temporary Assistance for Needy Families, but now with the work requirement, they may not qualify.

In a February 2016 interview with National Right to Life, one of the nation’s most prominent anti-choice groups, Gov. Pence said, “Life is winning in Indiana.” Though Pence was referring to the Real Alternatives contract, and the wave of anti-choice legislation sweeping through the state, it’s not clear what “life is winning” actually means. The state’s opioid epidemic claimed 1,172 lives in 2014, a statistically significant increase from the previous year, according to the Centers for Disease Control and Prevention. HIV infections have spread dramatically throughout the state, in part because of Pence’s unwillingness to support medically sound prevention practices. Indiana’s infant mortality rate is above the national average, and infant mortality among Black babies is even higher. And Pence has reduced access to prevention services such as those offered by Planned Parenthood through budget cuts and unnecessary regulations—while increasing spending on anti-choice crisis pregnancy centers.

Gov. Pence’s track record shows that these policies are no mistake. The medical and financial needs of his most vulnerable constituents have taken a backseat to religious ideology throughout his time in office. He has literally reallocated money for poor Hoosiers to fund anti-choice organizations. In his tenure as both a congressman and a governor, he’s proven that whether on a national or state level, he’s willing to put “pro-life” over quality-of-life for his constituents.

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