The Baltimore City Council went where no local government has gone before, it seems, in telling crisis pregnancy centers in the city this week that they have to put up signs saying they don't provide abortion or birth control.
At first glance, this seems suspect. Since when do governments go around demanding that particular groups put up any sort of signs, much less signs that specify what they don't do? Why should the city council single out these centers for distrust, compelled speech, and a form of punishment? And why would any woman walking into such a center expect to hear about abortion and birth control, anyway?
The answer to all these questions begins with the way in which the centers present themselves. They can be all about bait-and-switch. They hang their shingle out near a Planned Parenthood affiliate with a vague-sounding "pregnancy clinic" label. Some promise "all-options" pregnancy counseling or even, over the phone, information about abortion. They offer pregnancy tests and, with increasing frequency, ultrasounds to women who test positive. And then they lobby hard and exclusively for the mother to keep the baby or go the route of adoption. They give out diapers and baby clothes but no condoms. And if they talk about abortion, it's usually to falsely malign the procedure, claiming that it increases the risk of breast cancer or suicide or infertility (no good research supports any of those propositions).
We know these crisis pregnancy centers are trading in false information because of two separate investigations. In 2006, the office of Rep. Henry Waxman, D-Calif., asked investigators to call 23 crisis pregnancy centers. (The two biggest networks are Care Net and Heartbeat International; there are solo operators out there as well, representing a total of between 2,500 and 4,000 in the United States.) The Waxman report found that 20 of the 23, or 87 percent, wrongly tied abortion to breast cancer or infertility or mental illness in the information provided. These amounted to rampant government-funded lies, since the Bush administration funneled $60 million to crisis pregnancy centers between 2001 and 2005.
The second investigation, from 2008, is by NARAL Pro-Choice Maryland. Its investigators visited 11 centers in that state. By its account, 90 percent of the centers would discuss only abstinence or "natural family planning" as means of birth control. And every single one offered up some piece of false information. Some of the centers issued the usual litany of unsupported threats about suicide and breast cancer and infertility. And some got creative. One investigator said she was a Latina immigrant and was told it would be "very, very difficult" for her to get an abortion without legal resident status (false). At another center, a male counselor locked the door and acted "controlling and intimidating," the NARAL report states (nice). Think ACORN of the right, but without the video.
The NARAL report says that one center in Bowie, Md., states in its newsletter that 69 percent of the women who come in are under the age of 24. So you could argue that all the made-up misconceptions about abortion are also being poured into the ears of a population of women who are more vulnerable because they're younger and relatively inexperienced.
In the end, the Baltimore city council's vote protects consumers from false and misleading advertising. That's a position governments often take, and there's a whole branch of law, commercial speech, to explain why false advertising gets less First Amendment protection. The council decided to treat the crisis pregnancy centers differently than other groups because they're pretending to be something they're not (and then lying about the risks of abortion once they've gotten clients in the door). Eliot Spitzer similarly went after the centers for false advertising when he was New York attorney general. He investigated 24 of them and issued subpoenas to 11, saying they were violating a 1995 consent decree in which they'd promised not to misrepresent the services they offered.
The fight over how crisis pregnancy centers identify themselves is an old one that courts ruled on and Congress debated in the 1990s. And, of course, as with all things abortion, we remain deeply divided about them. A bill like the one that passed in Baltimore didn't get out of committee in the Maryland Legislature two years ago, says Planned Parenthood of Maryland President and CEO John Nugent. * A similar bill proposed in Congress in 2006 didn't go anywhere, either. There's also a battle over government money: A bunch of states fund the centers directly or through Choose Life license plates (which the courts are also divided about). But pro-choice groups got the Obama administration to kill the federal funding for the centers in the 2010 budget, when the White House cut off federal money for abstinence-only education.
All of which is to say that it's not clear who, if anyone, might follow the precedent Baltimore set this week. If, in fact, the measure becomes law—the mayor, who has troubles of her own, has three weeks to sign it or veto; if she does nothing, Nugent says, the new law stands. Assuming Baltimore goes forward with this bill, it will clear up some confusion and also cause some bitterness. The crisis pregnancy centers complain they're being singled out unfairly. An opponent of the bill on the city council said Planned Parenthood should be ordered to post signs, too.
Saying what, though—what does Planned Parenthood say it provides that it doesn't actually offer? "We have an obligation to do nondirective counseling," Nugent says. "For anyone who comes in and has a positive pregnancy test, we have to go through the options. That includes referring women for prenatal care, talking about keeping the baby, providing referrals to adoption agencies, and then also providing information about terminating the pregnancy. The only difference between us and any other ob-gyn is that we don't do deliveries."
My colleague Rachael Larimore draws a parallel between the Baltimore ordinance and moves by Oklahoma and South Dakota to force doctors to recite a certain script to women who are having abortions. Rachael's point is that if libertarians are willing to abide the scripts for the abortion providers, they have to accept the signs outside the crisis pregnancy centers, too. I see this in spirit, but I don't buy the parallel. The script ordered up by the South Dakota Legislature isn't designed to clear up confusion or ensure that women give informed consent. More like misinformed consent, since the South Dakota script repeats the untruth that abortion is linked to an increased risk of suicide, never mind that there's no good research to support this. It's easier to style the Oklahoma law that mandates an ultrasound before an abortion as a source of accurate information, since that's what ultrasounds provide. But Oklahoma doesn't tell doctors to make ultrasounds available to women who want them. It instructs abortion providers to provide the ultrasound or else. It's the extra dose of paternalism that's hard to swallow.
Baltimore, on the other hand, isn't telling the crisis pregnancy centers what to say after a woman walks in the door (despite all the made-up trashing of abortion that ensues). The city council just wants women to know what they're getting. The proposed signs would make clear what the crisis pregnancy centers are and what they're not. If they're playing it straight and owning their identity, in the end what's the problem?
Correction, Dec. 4, 2009: The article originally identified John Nugent as president and CEO of Planned Parenthood rather than of Planned Parenthood of Maryland. (Return to the corrected sentence.)