The first alarm bell went off in Ashley’s head when no one at the Prestonwood Pregnancy Center was wearing a mask. No one was in scrubs, no one’s hair was tied up, and every staffer was wearing a visible cross. “I should have noticed all the red flags,” says Ashley, 28, whom TIME is identifying by her first name to protect her privacy. But it wasn’t until she sat down for a mandated counseling session in the brick building in a Dallas suburb that she realized what kind of a facility it was.
Ashley was searching Google for a place where she could get an abortion and confirm her pregnancy. One of the first results had been a website called Choices Dallas offering “pre-screening abortion consultations.” That had led her to Prestonwood, one of more than 2,500 anti-abortion centers, sometimes known as “crisis pregnancy centers,” that have exploded across the U.S. in the past two decades, fueled by an increasingly powerful anti-abortion movement. These unregulated faith-based non-profits are now 3 times more than abortion clinics.
Millions of women visit these centers by mistake, like Ashley. The centers often present themselves as medical facilities and mirror abortion clinics’ logos, using names like Your Choice and Women’s Health Clinic. Prestonwood’s—a P at the center of three concentric circles—looks very similar, for instance, to that of Planned Parenthood. Pregnancy centers’ billboards—Pregnant? Scared? Need help?—blanket highways, and their well-funded parent organizations offer trainings in Google Ads, search-engine optimization, and social marketing to ensure they appear atop search results. They aim to discourage women from aborting their babies by encouraging parenting, adoption and providing counseling and baby supplies. Doctors and researchers found that the center also provides misinformation regarding abortion. TIME spoke to more than fifty women who were treated at these centers. Many of them said staff used scare tactics that included gory videos.
Ashley went to Prestonwood with the intention of receiving information and an ultrasound. A medical condition puts Ashley at high risk for an unplanned pregnancy. In this case, a fertilized embryo implants outside her uterus. The condition can cause an egg to die, and could also pose a threat to the pregnancy. But Ashley says the Prestonwood counselor told her, falsely, that she could carry an ectopic pregnancy to term if she was “careful,” and urged her to delay a decision to terminate the pregnancy. “I said, ‘OK, so you want me to wait until it becomes illegal for me to get an abortion?’” Ashley recalls, referring to a recent Texas law that bans abortions after roughly six weeks of pregnancy. Ashley wept in her car as she left the center. A Prestonwood spokesperson told TIME that it “abides by all relevant laws and regulations,” respects client privacy, and prioritizes “the health of both mother and child.”
Ashley saw a doctor to end her pregnancy and was able do so within the allowed time frame under Texas law. However, her trip to Prestonwood remained a haunting memory. She knew that she provided extensive personal information to an anti-abortion religious group through interactions over the telephone. Then she wondered what they might do with the data. “They scanned my ID. They knew my location, they knew my name and my F-cking License Number. It felt like a completely different violation.”
A sign against abortion outside Laredo Life Pregnancy Center in Laredo Texas on February 17, 2022.
Christopher Lee—The New York Times/Redux
She is not alone in her concerns. Privacy concerns about health apps and location data have been the focus of recent news stories about sensitive abortion data. However, TIME has learned that the vast amounts of personal data pregnancy centers store and collect posses a greater privacy risk. Numerous pregnancy centers are associated with anti-abortion organizations such as Care Net or Heartbeat International. They collect personal data on the millions of women that they contact each year, whether it is by phone, in person, or through chats. These data include sexual and reproductive histories and test results. They also contain photos of ultrasounds and other information that is shared with them during counseling, parenting classes or consultations. Some centers may require this before providing diapers. Privacy lawyers inform TIME that most of these centers do not have federally-required licenses to provide services and are therefore not subject to the privacy laws.
It is possible for the Supreme Court to be overthrown Roe V. WadeThese unregulated databases may be used in response to conservative attempts to criminalize abortion. In three states, lawmakers have passed legislation allowing individuals to sue abortion providers. Two states allow anyone who assists in abortions. Another proposed bill targets pregnant women. Pregnancy centers’ databases could be used as evidence in both launching and pursuing such legal actions. According to the strategy reports of pregnancy centers, women who are primarily focused on reaching out to urban women of color, they have a higher likelihood to be monitored and scrutinized by law enforcement.
“We anticipate that we will see a dramatic increase in the criminalization of pregnant people for self-managed abortion and pregnancy outcomes,” says Kim Clark, a lawyer at Legal Voice, a women’s-rights nonprofit in Seattle. “Pregnancy centers are just perfectly positioned to facilitate those investigations.”
The national anti-abortion organizations that run the largest networks of pregnancy centers say they protect their clients’ privacy. “That data is secure,” Heartbeat International spokeswoman Andrea Trudden tells TIME. “Any information that we publish and pull is just numbers, so we’re not looking at any of that [personal] information.” But some abortion-rights advocates point to conflicts of interest: Heartbeat, which runs the largest network of pregnancy centers in the U.S. with 1,800 affiliates, also lobbies for bills criminalizing abortion.
One of the most important lessons from the past decade is the fact that data troves unregulated can lead to privacy violations. The most intrusive front is now, as the repeal of abortion rights nears. “It’s just nuts,” says Mary Jo Daley, a Democratic state representative in Pennsylvania, who introduced a bill directed at pregnancy centers. “They’re collecting all this information, and you don’t know how they’re gonna use it because they’re not health care providers. And women don’t know that. It’s frightening.”
Locally-operated pregnancy centers emerged in the 1960s when mostly Catholic groups sought to stop abortions by providing mothers with counseling and referrals. After the Supreme Court established a constitutional right to abortion in 1973, larger groups, including evangelical activists, joined the so-called “pregnancy help movement,” according to the Charlotte Lozier Institute, an anti-abortion think tank associated with Susan B. Anthony Pro-Life America. The movement became more widespread and advocates started organizing their own pregnancy centers to form networks that included annual conferences and training sessions as well as digital and legislative strategies. The scaffolding for the anti-abortion national movement was once what had been small-scale mom-and-pop stores.
Media members gather in support of anti-abortion protestors demonstrating at the Supreme Court, Washington on June 21, 2022.
Stefani Reynolds—AFP/Getty Images
Pregnancy centers “go out of their way to perpetuate that idea that they’re just volunteers trying to help at a storefront on the corner,” says Megan Peterson, the executive director at the legal nonprofit Gender Justice. “There’s a whole machine behind them.”
By the late ’90s, conservative state lawmakers were channeling government funds to pregnancy centers to launch programs promoting sexual risk avoidance and alternatives to abortion. Nearly 20% of all pregnancy centers in the country receive government funding. According to an Equity Forward report, which is a research company that studies reproductive rights, 12 states send $8 million each year in taxpayer money to pregnant centers. Texas, however, provides more: $50 million per year. These centers are funded by at least 33 states, the District of Columbia, and specialty choose-life license plates. In addition, 10 states have used federal Temporary Assistance for Needy Families block grants that provide blocks of money to support vulnerable families to meet their basic needs.
As pregnancy centers spread nationally, many rebranded themselves as medical clinics, borrowing the language and imagery of women’s clinics—photos of people in white coats and exam tables—in their promotional materials. Today, the vast majority of centers do not provide even basic women’s health care, like Pap smears, and many oppose the use of birth control. According to Andrea Swartzendruber (associate professor, University of Georgia College of Public Health), 77% of these centers offer non-diagnostic ultrasonography, which does not give any information on the embryo’s health.
This decision to “go medical” was part of a national strategy to draw in more women explicitly considering abortion, according to the Charlotte Lozier Institute. However, confusion over the purpose of the centers was also exacerbated by this shift. “Our data show that many people who go to crisis pregnancy centers have misconceptions about what the centers are,” says Swartzendruber, who surveyed people who visited Georgia pregnancy centers. Many were “expecting an abortion facility or a medical facility.”
Search results on the internet have helped clarify this ambiguity. The 13 states which are planning to quickly ban abortion will be the most affected. Roe is overturned, nearly 40% of Google Maps searches for “abortion clinic near me” and “abortion pill” led to pregnancy centers, according to the misinformation research nonprofit Center for Countering Digital Hate. The top two search results for “abortion in Dallas” lead to pregnancy-center organizations, including Choices Dallas, the website that Ashley used.
Pregnancy centers have changed their strategies again in the last decade. This time, they are focusing more on data. Heartbeat International introduced a new data collection system in 2017 for its centers. “Big data is revolutionizing all sorts of industries,” its marketing materials trumpeted. “The data your organization collects needs to work not just for you, but for the rest of the pregnancy help movement.” Major pregnancy-center networks now use data-collection interfaces to track women who interact with their organization in person, on the phone, or online. Calling Heartbeat International’s 24-hour hotline, which the organization says fields some 1,100 calls a day, or using its online chatbot both require that a visitor provide her name, location, demographic information, and what she plans to do with her pregnancy.
These data-collection systems allow pregnancy centers to create “digital dossiers” of women, according to a 2020 report by U.K.-based civil rights group Privacy International, which warned that while these technologies “collect and centralise vast amount of people’s private information,” it’s unclear who the data is shared with. “You don’t need to physically go to a crisis pregnancy center anymore for them to harvest your data,” says Tara Murtha of Women’s Law Project, a legal-advocacy group. “They have it the moment you seek help on their website [or] use the chat app.”
Pregnancy-center staff often use the same data system for counseling and in-person consultations. These systems can include drop-down menus, or color-coded systems that help to determine if a client will get an abortion.
The trend for pregnancy centers to offer post-abortion counseling to women who’ve had an abortion is perhaps the most concerning to advocates of abortion rights. Heartbeat International also runs an “abortion-pill reversal” hotline directed at women who have started medical abortions. While the American College of Obstetricians and Gynecologists says there’s no scientific evidence suggesting that abortion-pill reversal works, the women who call the hotline asking about it are still asked to provide personal data. Murtha states that abortion can be illegal and this conversation could result in legal problems. “You’re on record,” she says, “as having been pregnant and attempted an abortion.”
Federal law does not regulate the information that is collected from pregnancy centers, unlike data obtained at real clinics. These centers do not fall under federal privacy laws. This includes the Health Insurance Portability and Accountability Act, which regulates healthcare settings. The state privacy laws are varied, however, only a handful of states have required that licensed pregnancy centers offer medical services. According to the Charlotte Lozier Institute’s 2020 report.
TIME examined more than twenty-six privacy disclosures for pregnancy-centers. It found that most of these references HIPAA, and provide broad data privacy. But most of the time, such promises are legally toothless since HIPAA does not apply, says Shannon Hartsfield, a lawyer at Holland & Knight who focuses on corporate compliance and data privacy. “They may say, ‘Oh, we keep everything confidential,’” she says, “but it’s going to be hard to know for sure without legal standards.”
It is important to read the fine print when filling out forms or visiting pregnancy centers websites. According to the terms of use on Heartbeat International’s data management system, the organization can share any and all client information with any “affiliates, partners, vendors, or contract organizations, or as legally necessary.”
Many pregnancy centers’ privacy disclosures note that they are not bound by federal medical-privacy laws, including HIPAA
Antiabortion leaders, as well as staff at local pregnancy centers, tell TIME that they have no intention of breaching their clients’ privacy. A coalition of antiabortion groups issued an open letter in May asking state legislators not to pass a Louisiana bill that classified abortion as homicide. “The mainstream pro-life movement absolutely opposes prosecuting women, and that extends to pregnancy centers,” National Right to Life Committee spokesperson Laura Echevarria tells TIME. In the face of opposition from the public, the Louisiana bill’s sponsor pulled the legislation.
Echevarria says that the future of maternal health care is dependent on pregnancy centers. A Heartbeat International survey showed that 41% of centers in Texas and surrounding states have seen an uptick in clients since Texas’ abortion ban took effect in September. Heartbeat spokeswoman Trudden says the organization’s primary concern is the recent increase in vandalism and threats to its centers, not data security. Even as abortion clinics have moved to paper forms and encrypted apps to protect clients’ information, Trudden says their centers are not making changes: “We have not received increased concerns by pregnancy-help organizations regarding their data security.” Echevarria adds that pregnancy centers have a “vested interest” in fighting law-enforcement requests to access their databases. “It would completely undermine and destroy the mission of pregnancy centers,” she says, “to have to give that information to anybody, to any court of law.”
The legal landscape is evolving rapidly. Texas’ six-week abortion ban offers a $10,000 reward to anyone who wins a civil case against either an abortion provider or someone who aided in an abortion. Oklahoma’s sweeping ban on abortion, which took effect May 1, also provides $10,000. Idaho has a similar law that is being blocked by the courts. RoeThe bill is still valid. National Right to Life issued a bill model on June 15. It would have banned nearly all abortions. Allow local officials to sue violators. Make punitive damages available to charities, even pregnancy centers.
Legal experts state that lawyers can subpoena data from the centers for information in cases under these laws. While most states don’t currently allow pregnant women to be punished for violating abortion restrictions, there’s a precedent for using such data to arrest or threaten legal action against women. According to the National Advocates for Pregnant Women, there have been over 1,700 cases in which law enforcement has taken legal action against pregnant women or arrested them in connection to pregnancies. In some cases, medical professionals gathered information and internet searches histories as evidence. The National Association of Defense Lawyers predicted a legal storm last summer. Roe is overturned, state anti-abortion laws “will open the door to mass criminalization on an unprecedented scale.”
Demonstrators for abortion rights and anti-abortion rallied in front the Supreme Court Building, June 21.
Brandon Bell—Getty Images
A substantial reward is offered by the Texas, Oklahoma, Idaho and National Right to Life models bills. This could be a motivator for all who have access to databases from pregnancy-centers. “The data,” says Peterson of Gender Justice, “literally has a price tag on it.” That includes pregnancy-center staff, partners, vendors, and contract organizations, the staff of which are presumably involved in this advocacy work because they believe that having an abortion is tantamount to murder. A front-desk attendant and spiritual counselor at Brazos Pregnancy Center in Texas who declined to give her name told TIME that while the center’s goal was to protect “the client and their baby,” she personally is “in the middle” on whether a woman should face criminal charges for having an abortion. The Opelousas Pregnancy Center in Louisiana goes further: its policies promise to treat clients “with kindness, compassion and in a caring manner,” while also asserting, “Abortion by any means for any reason is unjustified…and an act of murder.”
Pregnancy centers’ increasingly close ties to state governments present yet another concern, multiple legal and privacy experts tell TIME. Last year, Arkansas passed a law requiring women seeking an abortion to call an abortion-alternatives hotline, which in many cases would direct them to a pregnancy center. This law also requires callers to be assigned a unique number that can be used for identification purposes. The legislation has been proposed in five states. TIME spoke with Jim Dotson from Arkansas, who is the author of the bill. He said he opposed attempts to criminalize pregnant women, and that the data collected would be safe. Privacy experts disagree. In May, Daley, the Pennsylvania Democrat, introduced a bill barring the 156 pregnancy centers in the state from sharing women’s health data without their consent. They get state money, Daley tells TIME, “but they are not transparent, they’re not accountable.”
Meanwhile, Ashley, the woman who visited the pregnancy center near Dallas, says that she’s not sure where her data is stored or who has access to it, and she can’t help but feel that someone is looking over her shoulder. “I was within the legal bounds [to have an abortion],” she says. “But honest to God, it would not surprise me if someone were to knock on my door to see if I was still pregnant. I mean, it’s terrifying.”
— Simmone Shah reporting.
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