Culture & Conversation Abortion

How Anti-Choice Fake Clinics Leverage Technology to Trick People Out of Abortion Care

Elizabeth Skoski

"If you're pregnant, you can now text a number to get more information and you can talk with a crisis pregnancy center counselor exclusively over text if that's what you want."

Professor Jessie Daniels realized about a decade ago how sophisticated anti-choice marketing could be. One of the Hunter College professor’s sociology students gave a presentation about “post-abortion syndrome,” a made-up psychological disorder the anti-choice movement trumpets to discourage people from seeking abortions.

When she looked into her student’s source of information, Daniels was surprised by the elegant design and legitimate appearance of the anti-choice website TeenBreaks.com—a professional-looking website still in existence with ties to fake clinics, also known as “crisis pregnancy centers” or CPCs.

“Basically, what they’re doing is the soft sell,” said Daniels, who is also a professor at the Graduate Center of City University New York. On the websites, “they are kind of gently discussing these issues. And they’re also doing something much more pernicious by putting forward this language that my student quoted in her presentation about ‘post-abortion syndrome’: They’re co-opting clinical medical rhetoric for a ‘pro-life’ agenda.”

CPCs—nonprofit organizations established to counsel pregnant women against having abortions, often using false claims about the supposed health consequences of the procedure—have long used sly tactics to get people through their doors, from deceptive billboard advertising to attempting to appear “medical” or “clinical” through outfitting staff in white coats.

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Experts, however, say some in the industry are leveraging new technologies to spread its message in increasingly effective and intrusive ways, though it’s unclear yet how successful these new strategies are. These tools include sleek websites with advanced graphic user interfaces; the personal touch of using of text messages to reach out to those considering abortions; and even smartphone surveillance to target patients during visits to abortion clinics.

Kimberly Kelly, another sociology professor and director of gender studies at Mississippi State University, has examined the industry’s deceptive strategies since 2006. Kelly says it’s a movement that is focused on coming across as helpful, gentle, and comforting to those considering abortions.

“If you’re pregnant, you can now text a number to get more information and you can talk with a CPC counselor exclusively over text if that’s what you want,” Kelly said. She said some ads and billboards encourage pregnant people to text for information without even a hint that they’re paid for by anti-choice groups.

CPCs’ strategies go beyond smartphones and texting, however. They have also continued to take advantage of loopholes in existing technologies, such as search engine algorithms, for greater outreach.

More than a decade ago, CPC officials discovered online ads were a cheap and effective way to dramatically improve their reach, and spent the years since honing their strategies. In a 2005 missive now removed from the website of Care Net—a nonprofit organization that supports one of the largest CPC networks in North America—its then-president, Kurt Entsminger laid out how the organization developed its internet ad strategy. Entsminger wrote that a relatively modest $18,000 in online advertising generated more than 6,300 monthly calls and emails to the organization’s “Option Line,” its first line of contact in dissuading patients from seeking abortion.

“Of the women who contact the Option Line from the Internet believing they may be pregnant, about 80 percent are considering abortion as a pregnancy option,” Entsminger wrote.

He then explained that while Care Net ran a national ad campaign, its lessons could be duplicated using targeted, local searches.

“The good news is that the success which has been enjoyed by the Option Line with national keyword advertising can easily be translated to a successful local keyword advertising campaign for your center,” Entsminger wrote. “Once your center has developed a client-friendly website, you can begin generating new clients for your pregnancy centers.”

CPCs have continued to use this strategy for years. Due to paid ad campaigns, searching online for “abortion” or “abortion clinic” often returns results that place ads for CPCs above legitimate abortion facilities.  In 2014, NARAL Pro-Choice America led a campaign to persuade Google to remove such ads. At the time, Google said it removed about two-thirds of the ads.

But it still remains difficult to truly eliminate them from the top of Google searches, said Rebecca Griffin, associate director of California programs at NARAL Pro-Choice America.

“There [have] been communications, but it is a little bit like whack-a-mole in terms of keeping up with all these ads,” Griffin said. “It’s very daunting.”

Though it might be hard to keep up with the constant onslaught of new, misleading ads, Daniels thinks the public pressure generated by the NARAL study played an important short-term role.

“Once people start making a fuss, protesting, and calling out Google for some of it, the way it delivers search results, then they’ll make a statement saying ‘Oh, we’ve changed our algorithm,'” Daniels said. “And then time passes and those sites still come up pretty high in the search results.”

Potential confusion for patients is only exacerbated by the layouts of the websites themselves. Care Net affiliate centers can purchase a professionally designed web page for $150, choosing from premade templates with names like “Celebrate” (featuring a white woman blowing confetti at the viewer) and “Concise” (geared toward men, with the words “We can help you make the best choice—together”), and  “Concrete” (showcasing a Black woman with earbuds, posing against a wall of graffiti).

Kelly said this type of varied outreach is indicative of an effort to target diverse populations.

“Fifteen years ago, it was all pretty white girls,” Kelly says. “But now there’s much more of an effort when people are interfacing with their technology, now you see much more variation in the ethnicity of the models they are using.” Kelly highlighted recent coverage of CPCs referring to themselves as a “not-so underground railroad,” drawing parallels between themselves and those who helped slaves reach freedom. Activists have denounced this kind of strategy as racist and denigrating of Black women’s reproductive health choices.

A recent Media Matters for America (MMFA) report highlighted the anti-choice Human Coalition—responsible for multiple pieces in the New York Times‘ opinion pages—as another CPC organization taking advantage of technological tools. It pointed out that, in addition to the strategically targeted Google ads, Human Coalition web pages appear to be legitimate clinics providing abortion care and directing would-be patients to call the hotline “to speak to a specialist.” As MMFA noted, “According to the organization’s website, the contact center focuses on staffing ‘paid, trained call agents’ in order to ‘convert in-bound calls, chats, and texts into kept appointments” at CPCs in and beyond Human Coalition’s network.'”

As the internet continues to evolve beyond the age of web pages and manual search into the so-called “Internet of Things”—in which voice activation automates recommendations from services like Apple’s Siri, Google Home and Amazon Echo—some legal experts say not enough research has been done into the ways these new technologies can be manipulated to serve political needs.

The Amazon Echo, for instance, relies on Yelp—which a 2013 NARAL study found can be manipulated by CPCs—for many of its recommendations. When Rewire asked an Amazon Echo about abortion clinics in New York City, which has several Planned Parenthood locations as well as independent abortion clinics, the device returned a list that included only a single clinic that provides abortion services. The other suggestions included a CPC that, of course, does not perform abortions, a kidney dialysis center, and other irrelevant options.

In addition to false information, some experts cite privacy concerns associated with emerging technologies. Professors at the University of Oxford and the University of Tennessee examined the broader social implications of such devices in a forthcoming paper, which they provided an advanced copy of to Rewire.

Citing a recent criminal court case in which Amazon fought a police order to turn over Echo data, the authors, Maurice Stucke and Ariel Ezrachi, said the company acknowledged that there are significant social and political concerns about the information the devices collect and dispense.

“As one example, ‘users may ask for information about a sensitive health condition or a controversial political figure’…Thus, the digital personal assistant sweeps in a lot of data that can ‘reveal much more in combination than any isolated record,'” Stucke and Ezrachi wrote, citing Amazon’s own court filing.  “Those with access to the data can reconstruct ‘the sum of an individual’s private life.'”

Though not related to CPCs specifically, the case still sets a precedent for law enforcement’s ability to use people’s search histories against them, a particularly daunting reality in states where legislators are pushing to criminalize abortion. This tactic was used in the high-profile case of Purvi Patel, the Indiana woman convicted and later released on charges of feticide and felony neglect of a dependent for a self-induced abortion: During the trial, Patel’s internet search history for abortion-inducing drugs as well as her text messages with a friend were used as evidence against her.

As Amanda Marcotte noted for Slate in 2014, many CPCs do not charge for services and “fall outside the realm of being subject to consumer protection laws” that might theoretically require them to be transparent on their websites. While the fight to preserve individuals’ access to unbiased, fact-based information continues to play out on various technological landscapes, advocates say one key is in pressuring local legislators to regulate CPCs. Though that will not prevent users from being deceived in the first place, they point out, it will at least give them accurate information if they physically enter clinics.

Griffin praised California’s Reproductive Freedom, Accountability, Comprehensive Care, and Transparency (FACT) Act, which would require clinics to disseminate a notice to all clients in person stating that California has public programs providing free or low-cost family planning services, prenatal care, and abortion. The act also requires unlicensed facilities to notify clients that they are not licensed as a medical facilities by the state of California. Failure to comply could lead to fines of up to $1,000. Though Griffin is aware of the challenges that exist in combating the widespread misinformation—like getting similar laws on the books in other places and ensuring compliance with the laws—she is also bolstered by the upholding of policies similar to the Reproductive FACT Act in New York City and Baltimore.

“We really want to complement the work we’re doing to crack down on the search engine side with the local efforts that create more penalties and empower those jurisdictions to prosecute CPCs for false advertising,” Griffin said.

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