Reproductive Rights Under Siege: Unmasking the Dominance of Crisis Pregnancy Centers over Abortion Centers in America

by Caroline Soler (class of ‘25)

Today, the United States is geographically divided, not just by political beliefs but by access to critical healthcare, where a quiet but profound battle is being waged. In this post, I have created a map that displays a hidden dimension of the American healthcare landscape: the contrasting accessibility of Crisis Pregnancy Centers (CPCs) and legitimate abortion clinics. At the heart of this exploration lies a series of maps — not merely representing data but telling stories of how communities across the US are shaped by the availability, or lack thereof, of reproductive healthcare. By mapping out and quantifying this disparity through an “inaccessibility score,” this research does not merely present data but tells the profound stories of communities across the US affected by the availability, or the stark lack thereof, of reproductive healthcare services. It peels back the layers of political and social narratives to reveal a chilling picture of access and influence, where CPCs outnumber abortion centers in the majority of counties. View this post to learn more about the political aspects of this analysis.

Crisis pregnancy centers, also known as anti-abortion centers, are facilities that present themselves as providing reproductive health care services but aim to dissuade individuals from accessing abortion and contraception. These clinics are known for their deceptive and misleading practices, such as spreading medically debunked misinformation about the risks of abortion, overestimating gestational ages, and utilizing emotional manipulation to dissuade pregnant people from accessing abortions. CPCs appear in online searches, specifically on Google, as providing abortion services due to their strategic usage of keywords and web search manipulation. These facilities, especially those without medical professionals on staff, are not subject to federal privacy laws like HIPAA and thus are not legally required to safeguard patient information or confidentiality.

CPCs strategically prey on the most “abortion-vulnerable” sects of society, exploiting socio-economic, educational, and cultural vulnerabilities to further their agenda. Specifically, these facilities have been known to target people of color, young people, and under-resourced individuals who cannot generally afford or access abortion or reproductive care. CPCs often lure in economically disadvantaged individuals with free resources and parenting support. Additionally, CPCs relentlessly shame and psychologically manipulate their patients. The staff at these centers are known to refer to fetuses as “babies” and tell pregnant patients they are already mothers. This calculated exploitation by CPCs preys on vulnerabilities, deepening emotional distress and potentially perpetuating cycles of trauma under the guise of support.

Visualizing the Numbers: Mapping CPCs and Abortion Centers

In this post, I measure the presence of CPCs and abortion centers at the county level and explore their relationship with socioeconomic factors. My research reveals a clear pattern: a significant number of people seeking abortion care struggle with limited choices and a lack of accessibility. Notably, CPCs are more prevalent than abortion clinics nationwide, a trend prevailing even in many regions typically viewed as progressive. This disparity is more pronounced in conservative areas, where CPCs are significantly more common.

I collected information on the location of CPCs from the Crisis Pregnancy Center Map, an extensive online repository that maps the locations of these centers nationwide. This source was chosen for its comprehensive coverage and ongoing updates, ensuring the most current snapshot of CPCs’ distribution. For data on abortion centers, I obtained access to the Myers Abortion Facility Database, updated on September 1, 2023, a detailed collection of abortion facility locations, and for further socioeconomic factors, I employed the Open Intro Complete County dataset.

The cornerstone of this analysis is the creation of an “inaccessibility score.” This metric was developed by calculating the ratio of the number of CPCs to abortion centers in each county. Recognizing the diversity in county characteristics such as size, population density, and urban-rural spectrum, I employed a z-score standardization to these quotients. A z-score is a way to figure out how far and in what direction a data point is from the average, with positive z-scores demonstrating values above the average and negative ones below. In my research, the z-score measures how a county’s ratio of CPCs to abortion centers compares to the national average, with higher scores indicating more CPCs and lower scores indicating more abortion centers. This statistical method provides a normalized “inaccessibility score,” allowing equitable comparisons across counties with varying attributes. For example, a score of -0.5 on this scale would show a county where abortion centers outnumber CPCs at a high rate, whereas a score of 5 would denote a county where CPCs vastly outnumber abortion centers.

In examining the county-level distribution of CPCs and abortion centers across the United States, I find that roughly 52% of counties do not have any CPCs, affecting about 40 million US citizens. Meanwhile, close to 83% of counties lack abortion centers, impacting approximately 120 million US citizens. Perhaps most notably, about 45 million Americans live in counties that have at least one CPC but no abortion centers. This data starkly highlights a substantial disparity in access to reproductive healthcare services throughout the country. Additionally, the mean amount of CPCs per county is .834, while the mean amount of abortion centers per county is .423. Although these numbers are not directly applicable when thinking about actual clinics, they show how CPCs outnumber abortion centers across the country. This disparity underscores a challenging reality: millions of people seeking abortion services face limited or misleading options. This distribution reflects the broader social and political dynamics surrounding reproductive rights and emphasizes the urgent need for policy interventions to address the gaps in reproductive healthcare availability. The scarcity of abortion centers in most counties highlights a critical public health concern, potentially impacting the reproductive choices and well-being of numerous individuals in the United States.

Analysis

This map displays the inaccessibility scores of most US counties, colored by a gradient of light blue to dark blue — light blue being the “most accessible” and dark blue being the “least accessible.” The “inaccessibility score” quantifies the imbalance between CPCs and abortion clinics in US counties. It is calculated as a normalized ratio of CPCs to abortion centers to adjust for county-specific factors like population and area size. This score offers a comparative measure of reproductive healthcare access, where higher values indicate greater dominance of CPCs over abortion facilities. Counties with no CPCs or abortion centers were then colored by the counties nearest them with an inaccessibility score to visualize these trends fully. Those that are colored white are counties that did not have sufficient data. The counties with the highest access to reproductive healthcare, characterized by lower inaccessibility scores and represented by light blue on the map, include San Francisco, CA; New York, NY; Kings, NY; San Mateo, CA; and King, WA, while those with the lowest access, indicated by higher inaccessibility scores and darker blue hues, are Chester, PA; Montgomery, OH; Mercer, PA; St Louis, MO; and Erie, PA.

After running many correlation and regression tests, it is clear that socio-demographic factors — such as poverty, unemployment rate, and population of people of color — do not have a particularly strong relationship with accessibility nationwide. For example, the correlation between inaccessibility and median household income is weak, with a correlation coefficient of 0.08, as is the correlation with the unemployment rate (0.02), per capita income (0.07), and uninsured rates (-0.08). Factors like population size (0.01) and high school graduation rates (0.11) also show weak correlations. This suggests that inaccessibility to reproductive healthcare might be influenced by more complex or less tangible factors not captured in this dataset, like internet access, sexual education quality, or the local distribution of anti-abortion funding. The analysis underscores the importance of a more nuanced understanding of accessibility, including a broader array of variables and the interactions among socio-economic, geographical, and infrastructure factors.

A closer look at critical regions like California and Florida reveals instructive geographic trends. In California, most of the state has access to abortion centers; however, there is a pattern of inaccessibility in the midsouth — counties such as Kern, Tulare, San Luis Obispo, and Santa Barbara. I conducted a few correlation tests to understand further where these disparities come from. The results indicated that California’s inaccessibility score has a moderate negative correlation with median household income, with a correlation coefficient of -0.42, meaning that as household income increases, access to abortion services generally improves. Conversely, there’s a moderate positive correlation with the unemployment rate, with a correlation coefficient of 0.40, suggesting that higher unemployment in an area is associated with greater inaccessibility to abortion services. Similarly, a positive correlation with the uninsured rate, with a correlation coefficient of 0.35, shows that areas with more uninsured individuals tend to have less access to credible abortion services. Additionally, a positive correlation with the poverty rate among those under 18, with a correlation coefficient of 0.42, implies that higher levels of youth poverty correlate with greater inaccessibility.

The high school graduation rate exhibits a negative correlation with inaccessibility, with a correlation coefficient of -0.40, demonstrating that areas with lower graduation rates are likely to have reduced access to abortion services. This suggests that educational attainment is an essential factor, potentially affecting income levels, employment opportunities, and access to health insurance — all of which are interconnected with the availability of reproductive healthcare. However, it’s important to note that this trend is more pronounced at the state level; nationally, the correlation between socioeconomic variables and inaccessibility is nonexistent, which could be attributed to varying state laws governing abortion centers. In many states, restrictive laws have rendered abortion centers non-operational, leading to widespread inaccessibility regardless of socioeconomic factors. This creates a scenario where the relationship between socioeconomics and access to reproductive healthcare is more distinctly observed in states where abortion centers can operate more freely. This statistical relationship at the state level highlights the significant role of socio-economic factors and legislative environments in accessing reproductive healthcare.

CPCs are more prevalent in regions of California with economic challenges, suggesting targeted strategies by these centers to exploit socio-economic vulnerabilities. Policymakers must consider these findings to address the disparities and ensure that credible healthcare services, including abortion, are accessible to all Californians, particularly in socio-economically disadvantaged areas.

Florida is also a compelling case study as the state has become increasingly conservative in recent years, including in areas related to abortion. Between 2021 and 2022, voters in Florida left the Democratic Party at nearly twice the rate as they left the GOP. Hence, I was surprised that a few counties in South Florida have low inaccessibility scores, meaning higher levels of accessibility, like Miami Dade; thus, I explored potential factors and their relationship to my inaccessibility score to investigate why that is the case. Interestingly, both the uninsured rate and number of households speaking Spanish were negatively correlated with inaccessibility, albeit a low correlation of -0.13 for Spanish-speaking households and -.014 for the uninsured rate, meaning that Floridians who live in areas with a greater number of Spanish speakers and more uninsured individuals are more likely to have increased access to abortion centers in comparison to CPCs. To further investigate this relationship, I found that Florida counties that voted for Joe Biden in 2020 had inaccessibility scores of about .7 points less than counties that voted for Trump in 2020. This pattern of correlation with the political leanings of counties is something I explore in greater detail in this post.

These findings highlight important aspects of Florida’s reproductive healthcare landscape. The negative correlations with uninsured rates and the prevalence of Spanish-speaking households suggest that access to legitimate abortion services is somewhat more equitable than in California. This points to the importance of local socio-cultural dynamics in influencing healthcare access.

Conclusion

My investigation into the prevalence of CPCs compared to legitimate abortion clinics has unveiled the troubling dominance of CPCs. This dominance is not just a matter of numbers; it’s a reflection of the profound challenges and inequities in accessing authentic reproductive healthcare. The fact that CPCs are not bound by federal privacy laws like HIPAA is a critical concern. This loophole could potentially transform CPCs into surveillance entities, especially in regions where abortion laws are becoming increasingly restrictive. In such areas, CPCs could serve as tools for monitoring and potentially criminalizing abortion-related decisions. This scenario is not only a breach of privacy but also an alarming indication of how reproductive rights are being undermined in real-time, turning big data into a weapon against personal autonomy. The creation of an ‘inaccessibility score’ to quantify the disparity between CPCs and abortion centers has highlighted a stark reality. In many counties, individuals seeking abortion services are confronted with limited and often misleading options. The overwhelming presence of CPCs, combined with their lack of accountability in protecting patient information, poses a significant threat to the privacy and well-being of those seeking reproductive care.

There is an urgent need for informed policy decisions and public awareness about the deceptive nature of CPCs. As we move forward, we can not forget the importance of protecting reproductive rights and ensuring access to genuine healthcare services for all.