A global network of ‘crisis pregnancy centres’, backed by US anti-abortion groups linked to the Trump White House, has been condemned by lawmakers, doctors and rights advocates for targeting vulnerable women with “disinformation, emotional manipulation and outright deceit”.
There are thousands of such centres in the US. Many have been criticised for posing as neutral health facilities for women with crisis pregnancies while hiding their anti-abortion and religious agendas. But the global scale of these controversial activities has not been mapped until now.
In the first investigation of its kind, openDemocracy sent undercover reporters posing as vulnerable women with unwanted pregnancies to centres affiliated with the Ohio-based Heartbeat International in eighteen countries. Our investigation uncovered:
- women being falsely told abortion increases risks of cancer and mental illness; that a woman needs consent from a partner to access abortion; and that hospitals will refuse to treat medical complications from abortion
- staff encouraging women to delay abortion and emergency contraception
- training materials claiming that “condoms do not do a good job at preventing pregnancy”
- claims that abortion increases women’s risks of abusing their children
- suggestions that abortion can ‘turn’ a woman’s partner gay
- misleading advertising, including some centres that present themselves online as pro-choice support groups – or abortion providers
- staff at some centres offering ultrasounds without medical qualifications
In Italy, an undercover reporter was told not only that having an abortion can cause cancer, but that having a baby can cure serious illnesses including leukaemia. In Spain, another reporter was given an article that claimed that after an abortion a woman is “144% more likely” to physically abuse their children.
Nine months ago, we began following the money of two US religious right groups. Then, we deployed our own global network – of feminist investigative journalists.
In Mexico City, staff at one centre wrongly said that a woman needs her partner’s or a relative’s consent for an abortion – and that no hospital would treat her for serious complications. In Argentina, a reporter who said she was a survivor of domestic abuse was told by staff at another centre: “Now, you’re a victim, but getting an abortion would make you part of that violence.”
Heartbeat International claims close ties to the White House. Vice President Mike Pence has spoken at its events on Capitol Hill; Donald Trump applauded a 2018 Supreme Court decision in favour of crisis pregnancy centres; and Heartbeat has urged its allies to apply for funding from its “new friends in Washington”.
More than half of the centres openDemocracy visited are part of local networks that have received Heartbeat money. In Latin America, crisis pregnancy centres are also supported by Virginia-based Human Life International. Both groups oppose contraception as well as abortion.
In response to openDemocracy’s findings, politicians, doctors and rights campaigners have called for urgent government action and new regulations.
In South Africa, Department of Health deputy director-general Yogan Pillay said that the centres openDemocracy investigated “are violating the law and the national guidelines” by giving “directive” counselling. He said: “We will take action.”
In Mexico City, health secretary Oliva López said her department had previously received citizens’ complaints about “misinformation” at crisis pregnancy centres. She vowed to investigate and, “if applicable, impose sanctions”.
Lawmakers in Italy, Croatia, Ecuador and Argentina also called for government investigations. In Brussels, cross-party MEPs condemned these centres’ activities and Fred Matić, the European Parliament’s special rapporteur on sexual and reproductive rights and health, said this was “undoubtedly a violation of human rights, a grave risk for the lives of women and a serious threat to democracy”.
Meanwhile Florida Democratic Senator Cindy Polo, who recently visited El Salvador where women are imprisoned under abortion laws, said she was "shocked" at openDemocracy’s findings. She said it was "terrifying" that such groups are linked to the Trump administration, but warned that centres also get a lot of support at the state level: “In Florida our former governor very silently mandated that these ‘crisis pregnancy centers’ be funded by taxpayer money.”
“What has been most disturbing for me, as a woman of faith, is I find myself battling against folks who believe in the same God that I believe in,” she added.
"This is a grave risk for the lives of women and a serious threat to democracy"
Each of the countries in openDemocracy’s investigation has laws against false advertising. Some also have regulations on medical advice that say counsellors cannot push women to make any particular decisions about their healthcare.
In many cases, it appears that centres are breaking these laws or that there are loopholes that allow the centres to evade them. Some centres also appear to be breaching Heartbeat’s Commitment of Care, which requires affiliates to provide “accurate information” and “truthful and honest” advertising.
Responding to openDemocracy’s questions, Heartbeat pointed to recent US court rulings. Under First Amendment rights protecting free speech, those courts ruled that crisis pregnancy centres cannot be forced to provide women with information about abortion services.
“We stand firmly by our Commitment of Care... and by all our training resources designed for the pregnancy help community,” Heartbeat said. “Different countries have their cultures and varied ways of communicating, the fact remains that abortion carries risks to women.”
“With love and truth, our goal is to help the client understand abortion more fully, so that she can truly make an informed decision.”
Human Life International declined to respond to openDemocracy’s request for comment.
‘Friends in Washington’
Heartbeat International is one of several US pioneers of crisis pregnancy centres. These centres started opening in the US in the early 1970s ahead of the landmark ‘Roe v Wade’ Supreme Court ruling that legalised abortion across the country.
It has also spent almost $1 million around the world since 2007, including grants to more than a dozen specific anti-abortion groups and networks, according to openDemocracy’s analysis of its annual financial filings.
In Latin America, most of Heartbeat’s affiliates are part of a network that is also supported by Human Life International (HLI), which has spent $12 million internationally over the past decade. Unlike Heartbeat, HLI hasn’t disclosed its grantees’ names since 2008 and it is harder to follow its money overseas.
Heartbeat says it has visited more than 250 offices of members of the US Congress to lobby for crisis pregnancy centres since 2009 – and last month Donald Trump became the first US president to attend an annual anti-abortion rally in Washington DC, claiming that “unborn children have never had a stronger defender in the White House”.
Heartbeat itself says it does not get taxpayer money, but it has distributed state funding to some of its affiliates. In 2017, US journalists meanwhile revealed that immigrant minors who requested abortions while in federal custody were being referred to Heartbeat affiliates for counselling.
The following year, Trump appointee Scott Lloyd – who previously served on the board of a Heartbeat affiliate in Virginia and co-founded a Christian law firm based inside Human Life International’s headquarters – lost his job after it emerged that he had repeatedly mishandled abortion requests from migrant teenagers.
Human Life International, which also opposes LGBTIQ rights and promotes “natural family planning” instead of modern contraception, has a long history of scandals and inflammatory comments by its leaders and staff. One 2018 staff blog, for example, claimed that “abortion is the ideal cover-up for incest”.
Worldwide ‘misinformation’ networks
Around the world, Heartbeat says it has affiliates “on every inhabited continent” that pay small annual fees ($70 for international groups) and agree to follow standards on “accurate information” and advertising, among other issues.
Outside the US, openDemocracy found the most Heartbeat affiliates in Italy: more than 400, including dozens active inside public hospitals and women’s shelters.
Heartbeat has also given tens of thousands of dollars to the regional Centros de Ayuda para la Mujer (CAM) network that is also supported by Human Life International, and more than $200,000 to the Africa Cares for Life network in South Africa.
It is not clear what training specific grantees or affiliates have received. However, materials from one of Heartbeat’s online webinars, “developed from the experience of Heartbeat affiliates”, show how it teaches hotline operators to discourage or delay women from accessing abortions and emergency contraception.
Materials from a second webinar show how Heartbeat teaches incorrect medical information. For instance, it says that abortion can increase women’s risks of getting cancer and mental illnesses. There is no credible medical evidence for these claims, which have been repeatedly refuted by global health bodies.
“Don’t change your life. It’s your decision”
Many of Heartbeat’s affiliates appear to target vulnerable and marginalised women looking for abortion information and services, and only a few of the centres openDemocracy investigated were upfront about their anti-abortion agendas online.
Across Latin America, four of the five centres we visited appear to advertise online as if they were ‘pro-choice’ groups or abortion providers. In Mexico, for example, one centre advertises as a women’s support group on websites with names like interrumpir-embarazo.com (“interrupt pregnancy”) and aborto-mexico.com.
One Costa Rican centre, part of the same regional network that is a Heartbeat partner and grantee, advertises itself on a website called quieroabortarcr.com (‘iwanttogetanabortioncr.com’). In Ecuador, another centre says online: “Don’t change your life. It’s your decision,” and appears to offer medical abortion pills.
Inside one Italian hospital, our reporter found posters advertising one of these centres saying: “Are you concerned about a difficult or undesired pregnancy? Don’t stay all alone, call us” – without disclosing the centre’s anti-abortion position.
In Uganda, where abortion is illegal unless the woman’s life is at risk, one Heartbeat affiliate in a Kampala suburb advertises “abortion information” on a sign outside its building that says: “Are you pregnant and scared?” – much like the slogans on the billboards of anti-abortion crisis pregnancy centres across the US.
Guilt and ultrasounds
At almost every centre, including those visited in countries where abortion has been legal for decades, openDemocracy’s undercover reporters were made to feel guilty for considering ending pregnancies and pushed to continue them in all cases.
Staff at many of these centres used graphic language and imagery to describe abortions. In South Africa one such staff member told a reporter she might be “killing tomorrow's president”. In Ecuador, another reporter was warned that her womb could be “destroyed” if she had an abortion. Several reporters were asked for the contact details of the man who got them pregnant.
In Ukraine, our reporter called a centre’s hotline posing as an internally-displaced student, who had become pregnant after an unwanted sexual encounter. She was urged to turn to religion and confess in church. She was also warned that an abortion would threaten her soul as well as her health and her “ability to love and be happy in the future”.
Inside some of these crisis pregnancy centres, including those in Costa Rica and Mexico, staff offered reporters ultrasounds as part of ‘counselling’ sessions focused on dissuading them from accessing abortions.
The South African department of health’s deputy director general Yogam Pillay said he would be particularly concerned about this aspect of these centres' activities if they took place in South Africa, where “even nurses cannot do ultrasounds unless they have been specifically trained”.
This also appears to be in breach of Heartbeat’s own guidance on ultrasounds, which says that a centre that wants to offer these services must “become a medical clinic”, with a licensed medical director, insurance and a trained technician.
Emily Baile at the Expose Fake Clinics campaign in the US said that openDemocracy’s findings show how US groups have been “exporting” many of the “same lies about pregnancy and abortion that they have honed here at home”.
“Under the current administration in the US, these types of centres are becoming emboldened,” added Amy Bryant, assistant professor of obstetrics and gynaecology at the University of North Carolina’s medical school.
Bryant said that openDemocracy’s investigation has documented some “tactics I have not come across in the US, such as telling women that you need a partner’s permission”. But she added that their intent seems to be the same: “Deceive pregnant women who are seeking abortions by scaring them with fraudulent claims.”
“A rule of law issue”
In total, openDemocracy undercover reporters contacted and received advice from more than thirty ‘crisis centres’ in eighteen countries, in person or via their telephone hotlines. They were given misleading or manipulative counselling in most cases.
In Canada, most of Heartbeat’s affiliates explictly state on their websites that they do not refer for abortion services or provide professional counselling, although only about 40% put this on their front page. In most countries, these centres did not make their anti-abortion positions clear on the websites we reviewed.
“This investigation raises major concerns about these extremist groups who target women seeking healthcare,” said Ana Maria Bejar, advocacy director at the International Planned Parenthood Federation. She called for laws and information campaigns to counter groups spreading “harmful myths and bullying women”.
In Argentina, parliamentarian Mónica Macha said national authorities should investigate whether centres are acting illegally and added: “We need to discuss the legitimacy of these organisations that seek to evangelise on unwanted motherhood.
“These activities don’t empower anyone, don’t inform, don’t give counsel… they just seek to scare and create panic to push [women] into decisions based on false information and ideological traps. The goal is clear: prevent women’s autonomy.”
“This is a rule of law issue,” said Neil Datta, secretary of the European Parliamentary Forum for Sexual and Reproductive Rights. “Every politician, whether or not they agree with a women’s right to abortion, should be very concerned that their country’s laws are being circumvented through disinformation, emotional manipulation and outright deceit.”