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Playing Doctor

Siobhan O'Connor looks at the pro-life movement's new plan for family planning.

It's 7:47 on a Saturday morning in the Bronx, and a 32-foot-long RV, plush considering the surroundings, is taking up almost three full parking spots near the corner of Southern Boulevard on East 149th Street. Inside, the floors are carpeted, there's a comfortable couch, a microwave, a dishwasher, a mini-stove. There's a box of half-eaten Entenmann's danish on the counter, and a flat screen computer monitor on the table. It would almost look like a tour bus, were it not for the ultrasound machine in the back.A few yards up the street is an abortion clinic-though you'd likely miss it if you didn't know to look. There is a man in a security vest by the clinic's front door; next to him stands a woman who later identifies herself as Mary, with a half-dozen plastic rosaries dangling from her wrist and a fistful of pink pamphlets. With wild eyes, she watches oncoming foot traffic, approaching every young woman and couple she sees, bar none.A tough-looking girl with a bold gait-hair wrapped in a do-rag and legs poured into low-cut jeans-veers when Mary jumps into step with her. Nearby, a small group has convened in what appears to be a prayer for the unborn. Mary hands the young woman a few of her brochures; without stopping, the young woman sashays right past her-not inside the clinic, but down the block. It's impossible not to wonder if she rounded the corner and went in through the facility's back door. One can only guess.Consider this a very literal iteration of a battle that's going on in state legislatures across the country; in Congress and the Supreme Court; in medical clinics and the nearby pro-life centers that look just like them. This roving RV, one of roughly 3,400 pro-life counseling outposts nationwide known as crisis pregnancy centers, is evidence of a tactical shift in the anti-abortion movement-the idea being: Take the "choose life" message, dress it up to look medical (ideally with an ultrasound machine), and, in this case, take it on the road. Many of the centers offer free pregnancy tests, baby clothes and diapers, adoption referral, and parenting classes. What they don't offer is pregnancy prevention other than abstinence, abortion referral, or-in most cases-access to medical professionals. Since half the pregnancies in the country are unintended, critics say it's dangerous to be funding centers that don't offer complete family-planning options in addition to counseling.
This pamphlet advocates abstinence as the only medically-safe contraceptive option.\n
As it stands, CPCs have a PR problem. They have a well-documented reputation of persuading young women to continue pregnancies they say they don't want, showing them gruesome videos about abortion, and providing medical misinformation. One center even went so far as to pretend to offer a woman an abortion only to then delay the procedure until it was no longer a legal option.In response, less radical CPCs have been working hard to change that tainted reputation-one pro-life umbrella group has even gotten behind proposed legislation to regulate CPCs in Oregon. "They have really changed their tactics and techniques," says Sarah Wheat of Planned Parenthood Austin. "I think they are being a little more strategic about how they present themselves in an effort to increase their funding." Of course, the more organized and well-funded CPCs become, the more eyes are on them-and for CPCs that isn't always good news. A recent report by Representative Henry Waxman, Democrat of California, shook the abortion debate, confirming what reproductive-rights advocates have been saying for decades: that 87 percent of the centers investigated provided false and misleading medical information about abortion and contraception. This runs the gamut from claims that birth control leads to breast cancer to citing "evidence" that abortion causes women to later commit suicide.The Waxman report also tallied up the amount of federal funding these centers have received under the Bush administration. Since 2001, CPCs have received more than $30 million in federal dollars, and many states have also been generous (Texas has earmarked $5 million for counseling that steers women to abortion alternatives). In the last few years, these centers' funding strategies have changed dramatically. In the past, they relied heavily on private, often tax-deductible donations, as well as creative indirect money-gathering strategies, such as federal abstinence-only education contracts and state "Choose Life" license plates-for an extra $20 to $50, people can customize their plates with a pro-life message; the extra cash goes straight to CPCs. "There's a new trend with governors and state legislatures being much more bold in their willingness to secure direct funding for CPCs," Planned Parenthood's director of government relations, Jackie Payne, confirms.\n\n\n
Soon everyone will have to look at ultrasounds of a fetus they don't want because they won't be able to find a family-planning clinic.
Currently, in the United States, there are two CPCs for every abortion clinic, a ratio that will only grow more lopsided as abortion becomes more regulated, bans are upheld, and national and state family-planning dollars are redirected to CPCs. "Only 13 percent of counties in the U.S. have abortion providers," says Payne. "Soon everyone will have to look at ultrasounds of a fetus they don't want because they won't be able to find a family-planning clinic."New York State has the dubious distinction of being the abortion capital of America-it performs 10 percent of the country's abortions, making it a focal point for some pro-lifers. "This is the front line for abortion in America," says Chris Slattery, from the passenger seat of the RV in the Bronx. Slattery runs the RV and 15 other pregnancy centers in the city, many of which are strategically positioned across the street from (or in the same buildings as) Planned Parenthood centers.After about an hour and a half of sidewalk counseling, Slattery's coworkers, joined by Mary from the Helpers of God's Precious Infants, have stopped dozens of passersby, handing out as many leaflets. A knock on the van's door animates the sonographer, who has shimmied into a nurse-blue vest, ready to get to work. The visitor is a 20-year-old, light-skinned black woman, dressed Saturday casual in a gray sweat suit and Nikes, hair yanked into a high ponytail. She is a mother of two-she had her first child at 18, her second at 19, both unplanned-and she came here unsure, she says. The counselor asks her if she believes in God (she does); if she has heard about the "medical risks associated with abortion" (she has); and if she wants to watch a video about fetal development (sure). Finally, it's sonogram time. The sonographer slides the accordion door shut, and the young women can be heard giggling, as echoes and white noise fill the bus. "That's the baby's heartbeat," Slattery tells me matter-of-factly. We later find out that the pregnancy was six weeks along. After the woman leaves, it's smiles all round. "Another save!" he says.Herein lies the crux of the controversy surrounding CPCs: their increasing use of the sonogram as a persuasive tool and their dispersal of health information refuted by every major medical association in the country, as well as the government. This is the heart of the debate-both sides fundamentally disagreeing on the science behind the information they provide. Do pro-lifers actually believe the National Cancer Institute is so entangled with the pro-choice movement that it is obscuring a causal relationship between abortion and breast cancer, or is this assertion merely an effective tool for coercion they don't want to give up? Depends on whom you ask.
Intimidating text from a crisis pregnancy center's flyer.\n
"What concerns me is that if a woman goes to a CPC and has an ultrasound," says Jessica Farrar of the Texas State House of Representatives, "she thinks she's receiving medical care. But there might be a birth defect or some other issue related to her health that would fail to be diagnosed because there are not the right medical staff there. CPCs are often the first line of observation, but a woman could walk out that door thinking everything is fine with her, when it's not." Some reproductive-rights advocates are asking that CPCs be required by law to post a sign that says "This is not a medical facility" in the entranceway.Meanwhile, 550 pregnancy centers are already equipped with ultrasound, with another 100 in the works this year, says Beth Chase, the executive director of the medical advancement division of the pro-life umbrella group National Institute of Family and Life Advocates. According to an article by NIFLA's president, Thomas Glessner, CPCs are reporting fewer and fewer clients seeking abortions, so a "major challenge … will be to find new methods to attract abortion-minded women." The strategy? A nationwide effort to convert CPCs into what they call full-blown medical facilities. "Full-blown," of course, is a relative term.Chase is a thoughtful, soft-spoken woman-the kind of person who uses your first name when she talks to you, whom you can hear smiling as she describes the positive impact CPCs have had on her clients. The new centers she calls "pregnancy help medical clinics" are equipped with ultrasound machines and many are offering free early prenatal care, Sexually Transmitted Infection testing, and standard medical services associated that appointment. What they don't offer is abortion referral, contraception or, in most cases, visits with a licensed OB-GYN. "Under the supervision of a licensed physician, an ultrasound exam is performed by a medical professional to confirm a viable intrauterine pregnancy," she says. "And during that time a woman can also be introduced to her baby for the first time."A woman named Bethany, with 13 years of experience at a Dallas abortion clinic, finds this particularly troubling. "It isn't the sonogram itself that is objectionable, but the highly unethical purpose for which it is used," she says. "A sonogram picture from a medical facility has information printed on it, such as measurements in millimeters for purposes of determining the stage of pregnancy. I have had pictures from CPCs handed to me by 16-year-old [clients of mine], with the words ‘Hi, Mommy!' where the medical data should be."As crisis pregnancy centers become more like medical clinics, other problems emerge. Right now there are no sweeping regulations for these centers, though Oregon and Texas have proposed Senate bills attempting to change that. On the other hand, some people are concerned that the more medical CPCs become, the more powerful they will actually be. And as it stands, women have often reported confusion about the difference between a CPC and a medical clinic. Amanda Hill, for example, was 19 and living in a trailer home in Huntsville, Texas, when her period was a week late. She looked in the phone book and found a large ad boasting "free, anonymous pregnancy tests and pregnancy options counseling." She headed over that afternoon.
A pamphlet that erroneously links abortion and breast cancer.\n
After her test, she says, she was left alone in a pamphlet-filled room for half an hour. "Finally, a counselor wearing a white lab coat and carrying a clipboard came into the room pulling a TV on a rolling cart behind her," she says. She suspected that the clipboard had her results, but before she could get them, she'd have to watch a video about prenatal development. "It started with a quote about how at the moment of conception you are given a road map to be complete as a woman," Amanda recalls. "It was really powerful, heart-wrenching stuff, and the pictures of the fetuses looked like full babies."The counselor then asked Amanda what she would do were she pregnant. "When I told her, she asked me how my parents would feel about me killing their grandkid," she says. She was told she was on a destructive life path, and was encouraged to pray with the counselor (Amanda is not Christian). About an hour later, the counselor sent her on her way with a bunch of pamphlets. She wasn't even pregnant.The RV has been parked by the clinic's front door almost every morning for two months now. Its presence has been without major incident, though it's impossible to know the impact it's had on the young women passing by, preparing to make one of the most personal decisions of their lives. Planned Parenthood has called it a trap. The clinic staff declined to comment.Slattery, for his part, feels his work has been an unqualified success. In his 20-odd years of pro-life work, he says he's counseled 70,000 women. "We could fill Madison Square Garden with our saves," he says. "They come in here more afraid of their child, and they leave more afraid of abortion."The morning sun is getting brighter, and around 10 a.m. another sidewalk counselor turns up with his two young daughters, the youngest monkeyed around his waist, the other by his side. His glasses are thick and it's hard to see his eyes, but he has the demeanor of the deeply spiritual-stoic, squinty, gentle. Soon, the three of them will join the growing vigil set up by the clinic's front door.Inside, the clinic's waiting room looks like any medical triage center-tidy rows of chairs, every seat taken, a few people slumped against the taupe walls, mouths open, fast asleep. Couples sit with their fingers clenched so tightly that the blood appears to be draining from their knuckles. Some girls giggle and whisper, other girls sit alone.Just outside the back door, by the waiting room, a man of about 25 is smoking a Newport, shifting his weight from one foot to the other. "They tried to stop us on our way in," he says, cocking his chin without looking up. Across the parking lot, a lone man holds a stack of blue and green pamphlets. "They were persistent, too." He shakes his head and with a swift exhale says, "We're going to be okay. We'll come out the back door."

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