The global impact of crisis pregnancy centers (CPCs), or anti-choice clinics, hasn’t been fully understood until now.

A study led by U.K.-based political website openDemocracy found the United States as the epicenter of a worldwide network of anti-choice clinics targeting people with “disinformation, emotional manipulation, and outright deceit” about reproductive health. 

Bolstered by lawmakers who oppose abortion rights and anti-choice groups like Heartbeat International and Next Level, these clinics are designed to appear as neutral health-care facilities when in reality they harbor blatant anti-abortion agendas and frequently provide vulnerable people with medically inaccurate information. 

OpenDemocracy‘s undercover reporters, posing as pregnant women, found that Ohio-based Heartbeat International, which runs thousands of clinics in the United States, has affiliate clinics in more than 18 countries, including Argentina, Costa Rica, Croatia, Ecuador, Italy, Mexico, and South Africa. 

According to the findings, Heartbeat International-funded and -trained clinics are responsible for falsely telling people “abortion increases risks of cancer or mental illness; that a woman needs consent from a partner to access abortion; and that hospitals will refuse to treat medical complications from abortion.” The research uncovered training materials claiming “condoms do not do a good job of preventing pregnancy” and advertising claiming some Heartbeat International centers are abortion clinics. One Costa Rican clinic investigated for the report advertises on the website quieroabortarcr.com or iwanttogetanabortioncr.com.

Since 2007, Heartbeat International has spent around $1 million overseas “including direct support to more than a dozen anti-abortion groups around the world,” openDemocracy reported. Heartbeat International is a 501 (c) 3 organization that’s funded primarily through grants and private donations. In 2018, the group received $4.7 million in grants, donations, membership fees, and program revenue.

Support from the White House 

The fight against the worldwide misinformation campaign surrounding reproductive health is spreading. After openDemocracy’s report was released, policymakers from Argentina, Croatia, Ecuador, Italy, Mexico, and South Africa have spoken out about the illegality of Heartbeat International’s actions, with some promising investigations. 

“This is a rule of law issue,” Neil Datta, secretary of the European Parliamentary Forum for Sexual and Reproductive Rights (EPF), told openDemocracy. “Every politician whether or not they agree with a woman’s right to abortion should be very concerned that their country’s laws are being circumvented through disinformation, emotional manipulation, and outright deceit.”

Heartbeat International has prominent ties to the White House. Each year before the annual March for Life, the organization brings supporters to Capitol Hill for a roundtable discussion with politicians. In January 2019, Vice President Mike Pence attended the event. 

President Donald Trump has expressed support for so-called crisis pregnancy centers. He recognized the anniversary of a 2018 ruling in which conservatives on the U.S. Supreme Court sided with anti-choice clinics, striking a California law requiring clinics to inform patients of all their reproductive health-care options. Meanwhile, the Trump administration has gutted the Title X family planning program and funneled the federal funds into clinics run by anti-choice activists. 

“The situation in the United States is growing more dire, and I fear for the state of sexual and reproductive health services, particularly for women in rural areas, low-income women, and women of color, who predominantly seek these services,” Dr. Amy Bryant, professor at the University of North Carolina School of Medicine, said in a statement to openDemocracy, adding that anti-choice clinics have been “emboldened” during the Trump presidency. 

Marketing of deceit 

Disinformation and emotional manipulation aren’t the only tactics U.S.-based anti-choice organizations are focused on. Data mining has been a focal point for Next Level, a Heartbeat International subsidiary that created a global content management system used to store personal patient information, according to Privacy International, a London-based human rights charity group advocating for privacy around the world. Information in the system includes details from the intake forms at anti-choice clinics, like a person’s name, address, email address, ethnicity, marital status, education, income source, medication, medical, pregnancy history, medical testing information, and eventually, ultrasound photos.

It’s not clear how this information is being used. Next Level on its website has said it “may share such information with Next Level affiliates, partners, vendors or contract organizations, as legally necessary.” Heartbeat International has 2,700 affiliate organizations and partners within its network worldwide.

As Rewire.News has reported, Heartbeat developed a program called Option Line, a website, chat service, and call line used on anti-choice websites. According to their terms of use, “all remarks” sent through Option Line can be used “for any and all purposes” it believes “to be appropriate to the mission and vision of Option Line.” This explanation leaves the door open for personal data to be misused in a variety of ways.

With Heartbeat International’s uncovered manipulations—misrepresenting anti-choice clinics as abortion care centers—and its utilization of vast amounts of personal data to potentially create “digital profiles” of prospective patients, the organization is paving the way for the marketing of deceit, threatening access to abortion care around the world.

Emily Baile, from the organization Expose Fake Clinics, said anti-choice clinics “evolved out of violent abortion clinic protesters.” “When it became illegal to chain yourself to the front gate of abortion clinics, protesters changed tactics and began creating crisis pregnancy centers throughout the United States,” she said in a statement to openDemocracy.

The “fraudulent advertising” and the dispensing of inaccurate advice are “crimes and should be stopped by the government,” Baile said. “No person should be tricked or manipulated when trying to access time-sensitive health care,” she said. “The fraudulent nature and disruptive tactics by the centers have no place in lawful societies.”

Correction: A previous version of this article said Option Line was developed by a Heartbeat International subsidiary.