(Bloomberg) -- When Lisa suspected she was pregnant, she did what other teenagers might: She Googled her options to terminate. One of the first links that popped up in the search engine was a clinic in Volusia, Florida, where the 19-year-old lived. The offer of a free pregnancy test tempted Lisa into booking an appointment and she drove there with her boyfriend, parking across the street. It was a small town, and she did not want to be recognized.
The consultation room was filled with posters depicting fetuses with speech bubbles, as if they were asking to be born. Lisa sobbed as one of the women running the clinic confirmed she was pregnant; they had refused to let her take a test home. Lisa needed to return for an ultrasound in four weeks to be certain, and then they could discuss options. But until then, they told her, she absolutely should not go to an abortion clinic. “Maybe you’ll miscarry and then you won’t have any problems,” the woman suggested.
As Lisa started to realize it wasn’t a medical facility, she became terrified for her privacy. “This information can’t go anywhere, right?” she begged a receptionist on her way out the door. “No one is gonna know that I was here?”
The answer wasn’t reassuring. “I remember her saying: ‘Well, honey, this is what happens when you have sex.’”
Lisa, who asked not to be identified by her real name, did manage to get an abortion from a different provider. But she also ended up in a database. The center continued to call her every few weeks to ask for an update on the baby and offer parenting classes. And as women like Lisa around the country are led unsuspectingly into anti-abortion centers, known as “crisis pregnancy centers,” academics and advocates for reproductive rights are concerned about what happens to this potentially incriminating data — especially after abortion becomes illegal in many states following Friday’s Roe v. Wade ruling.
Meanwhile, the crisis pregnancy nonprofits are sharpening their digital skills, investing their donations and state funding into outreach on social media, targeting teens and young adults. The centers have poured money into advertising on search and social media products such as TikTok, Instagram and Snapchat. And some of them have begun using these platforms to spread not merely marketing messages but also what physicians and other health care professionals say is harmful misinformation.
On Snapchat, for instance, the centers appear to have been using the app to gain exposure to teenagers and women in their early 20s, Snapchat’s core audience. When searching in California, each of the nine businesses listed on Snap Maps under “pregnancy tests” are anti-abortion clinics. That's also true for all all but one of the 10 listed when searching for “pregnancy.” Eleven of the 24 locations listed under “abortion” on Snap Maps in the same location were anti-abortion clinics. Three offered the so-called abortion reversal pill, which is considered dangerous by the American College of Obstetricians and Gynecologists, due to risk of hemorrhaging.
Snapchat removed dozens of anti-abortion clinics from its Snap Map feature after Bloomberg News raised questions.
The crisis pregnancy centers, which often also offer services such as adoption planning, have long tried to be listed alongside legitimate reproductive health providers in order to reach an audience. Google, for instance, now requires providers to note whether businesses are accredited to perform abortions or not, but the deceptive centers still remain en masse in states where women may no longer be able to find legitimate treatment.
Choose Life Marketing, a digital marketing company that works with anti-abortion clinics in the US and Ireland, said in training material posted to its website that Snapchat is a great place to advertise to the younger generation. It gives tips on how to include imagery with young people wearing baggy clothing or hairstyles that reflect Gen Z.
“Like Facebook and Instagram, it would accelerate the word of mouth that has brought clients through your doors for many years,” the Choose Life Marketing site said. Snapchat advertisements in particular “were effective at getting clients to directly respond to the ad and call pregnancy centers for appointments.”
Anti-abortion organizations have gotten more savvy about tracking their visitors and collecting information that isn’t protected by medical privacy laws. Tara Murtha, communications director at Women’s Law Project, said that if women in states where abortions are restricted visit a center and then fail to have a baby, there’s a record that could be passed into the hands of “overzealous prosecutors,” examples of which have almost tripled in the last 12 years.
“There’s going to be policing and surveillance of pregnant people and, if there’s an adverse outcome other than a full term, healthy baby, that could invite investigation into what that person might have done to cause that,” Murtha said.
Heartbeat International, an Ohio-based organization that runs thousands of anti-abortion clinics around the country and globally, offers a software called Next Level Center Management Solution. It costs $100 a month to hold more than 20,000 names of women who visit a center. It helps centers keep in touch over emails and phone calls, or track donations to the center. It offers integration with QuickBooks, accounting software from Intuit, which did not comment.
“The data your organization collects needs to work not just for you, but for the rest of the pregnancy help movement,” the website states. “As big data revolutionizes industries around the globe, now is the time to do the same for life-affirming work of pregnancy help. As we pool together what we’ve learned separately, we can begin to wield game-changing predictive and prescriptive analytics that lead to stronger outcomes.”
The National Institute of Family and Life Advocates, a charity that provides training and legal advice to more than 1,000 anti-abortion clinics across the US, was listed as a Choose Life Marketing partner on the advertising firm’s website, according to a screenshot that Jack Dobkin, a researcher at rights nonprofit Equity Forward, sent to Bloomberg News. The site removed the reference after Dobkin published a report revealing the link in April. Choose Life Marketing and NIFLA did not respond to a request for comment.
“Their goal is to collect and store ultrasound photos, income, history of possible abuse in relationships, history of addictions, history of drug use, your STI history, your medical history,” Murtha said. “And in many cases this is shared in a national database.”
Anti-abortion clinics often use medical misinformation to draw women in, Dobkin said. One of the clinics appearing on Snap Map claimed, inaccurately, that it was “vital for you to have an ultrasound before you have an abortion,” a common tactic used to try to persuade women to abandon plans to terminate a pregnancy.
Anti-abortion centers used graphic descriptions to suggest abortions were unsafe and several overstated the risks of the procedure. They included graphic descriptions of “scraping,” and claimed that many women bleed to death after a surgical abortion. Abortions are overwhelmingly consided safe by medical professionals: A study published in the Lancet last November found that 99% of patients who took the first abortion pill, and 94% of those who took both, experienced a successful abortion with no medical complications.
Another center claimed that abortion clinics were overrun and local wait times were so long it that it would be in the patient’s best interest to schedule a same-day appointment at its office instead. There are roughly three times as many anti-abortion centers as there are abortion clinics in the US, allowing these clinics to capitalize on hurdles created by legal restrictions at the state level. This could narrow the amount of time a woman has to plan a safe abortion.
Snap Inc. spokeswoman Rachel Racusen said that Snapchat had no control over the websites that listings on its app sent users to, but said the company felt a “deep responsibility to ensure content on its platform is accurate” and that it encouraged users to report concerning content. Snap allows abortion-related advertising but not medical misinformation or disinformation, she said.
Some of the anti-abortion clinics that appeared under “abortion” on Snap Map offered the so-called abortion reversal pill. A “reversal” is a dangerous yet increasingly common scenario where a woman takes a high dose of the hormone progesterone after taking the first of two abortion pills.
Despite social media companies’ attempts to remove medical misinformation, abortion reversal advertising has continued. Facebook said it would remove abortion reversal advertising in September 2021 but it has published 19 reversal campaigns worth $65,591 in revenue between September 2021 and May 2022, according to research that the Center for Countering Digital Hate shared with Bloomberg News.
Since 2020, Facebook has taken in $202,258 in advertising revenue for reversal ads, which have been seen 23 million times. Two additional advertisement campaigns for reversal procedures appeared on Facebook on May 16, but Bloomberg News was unable to see how many times they had been viewed or the advertising revenue they generated in Facebook’s advertising library. Facebook did not comment but a spokesman said that it had removed one of the advertisements for violating its policy against promoting prescription medication.
Research suggests that most women who visit these clinics with the intention of getting an abortion will go on to do so. Still, many of the women who visit are not even pregnant and want to use the free services the clinics offer, which come with tie-ins like signing up to a program and handing over personal information. This has led academics and researchers to believe they have an alternative primary goal than just convincing pregnant women not to have an abortion.
“They receive funding under their alternative to abortion programs, but according to their own data, they are not successful at that,” said Murtha. “So what are they successful at? Siphoning public money into the anti-abortion industry.” In 2021, 13 states had state-backed funding for anti-abortion clinics for offering maternal services, according to Equity Forward.
Elisa Wells, a co-founder and co-director of the abortion-pill advocacy group Plan C, said anti-abortion clinics are stealing her businesses’ text to appear higher in Google searches and confuse patients. Following an interview with Wells, a search for a “Plan C” on Google surfaced an ad that looked like it came from the organization, but was the work of a Memphis-based anti-abortion group that alleged there were risks involved with taking the abortion pill.
“The fact that these algorithms and holds or blockages of ads are making it harder to find that information is really something that’s concerning to us,” Wells said.
Google said that it now requires clinics that do not offer abortions to make that clear and that it was “exploring ways to make these disclosures more visible.”
To counter the increased spending by anti-abortion activists, abortion provider Planned Parenthood is putting more money into social media, too. It spent an estimated $178,000 on Snap advertising this year in comparison with $86,000 in 2021, a company spokesperson said, and nearly $2 million on advertising across Facebook and Instagram since May 3, a day after the draft of the proposal to overturn Roe v. Wade was leaked. That accounts for around 20% of Planned Parenthood’s overall spending on the platform since 2018, when Facebook’s owner Meta Platforms Inc. began publishing political advertising figures.
“There is overwhelming support for abortion access in this country, but our reproductive rights are under attack like never before from politicians who want to control our bodies and our futures,” said Sam Lau, Senior Director of Advocacy Communications at Planned Parenthood. “That’s why we’re leveraging the power of digital platforms and running ads.”
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