San Francisco is home to three clinics, located in Bernal Heights, Potrero Hill and the Haight, that offer abortion services. Two other facilities, in the Outer Mission and Union Square, vend anti-abortion messages in the guise of providing family planning assistance.
Variously called “crisis pregnancy centers” (CPCs), “pregnancy counselling centers,” “limited service pregnancy centers” (LSPCs) and “pro-choice counselling clinics,” anti-abortion facilities market themselves as offering options to pregnant women, including abortions. In reality, however, they’re typically faith-based, anti-abortion and only provide narrowly-defined counselling, “emotional support,” and “community resources” to women seeking their help.
CPCs try to persuade women who are considering an abortion to carry the fetus to term. According to NARAL Pro Choice California and other pro-choice organizations, CPCs’ apply emotional abuse, harsh judgement, and lies about abortion’s side-effects to pressure women into changing their minds. One NARAL investigator, posing as a pregnant woman in need of help, was told to “stop whoring around.” Other women have been stalled through the use of “required” check-ins to make them wait long enough that an abortion was no longer possible.
The San Francisco Pregnancy Information Disclosure and Protection Ordinance, passed in 2011, forbids clinics from presenting false or misleading advertising or to imply that they offer services that they don’t. The order requires facilities to explicitly state whether or not they provide abortion services or referrals. CPCs claim that such ordinances violate the First Amendment, a freedom of speech argument that caused similar rules in Baltimore and New York to be repealed.
First Resort Pregnancy Center, a Bay Area chain that has rebranded itself as Third Box Pregnancy Clinics, and now Support Circle Clinics, challenged San Francisco’s ordinance in federal court. In response, City Attorney Dennis Herrera argued that First Resort’s advertising is “an insidious practice that victimizes women who are, in some instances, already victims. It’s especially problematic because these centers can cause interfere with women’s time-sensitive, constitutionally protected right to reproductive choice.” In 2015, the law was upheld by U.S. District Judge Saundra Brown Armstrong of Oakland.
“The issues here are about accuracy in advertising and making sure that women aren’t misled,” said Amy Everitt, NARAL Pro Choice California director. “Regardless of where you stand on abortion, most people can agree that women should get accurate information when looking for information about their health-care options.”
In 2015, California became the first state to require CPCs to post information about free and low-cost public programs for family planning, abortion services and prenatal care. Assembly Bill 775, the Reproductive FACT Act, marks reproductive rights advocates’ first success at state regulation of CPCs. However, NARAL discovered through undercover investigations that not all CPCs are abiding by the law. “We have really progressive, really fabulous laws,” said Everitt. “But if they aren’t enforced they don’t mean anything.”
NARAL investigators visited 43 of California’s 228 CPCs, and found that regardless of a service-seeker’s situation – whether or not she was financially stable, in an abusive relationship, in school, or mentally prepared to go through with the pregnancy, among other factors – CPCs’ unwavering message was to complete the pregnancy. NARAL observed that CPCs’ staff seemed to all be reading from the same script, conveying consistent falsehoods about abortions that the medical community has rejected. Of the CPCs NARAL visited, 46 percent claimed falsely that abortion and breast cancer are linked; and 35 percent asserted that abortion causes fertility issues. A 2008 American Psychological Association study, as well as a 2013 University of California, San Francisco report, concluded that a woman who is forced to carry a fetus to term will suffer more mental health problems than one who decided to have an abortion.
Support Circle Clinic maintains an office at 450 Sutter Street, with two others located in Oakland and Redwood City. According to case files from First Resort’s – Support Circle’s predecessor – AB 775 challenge, the clinic believes that “…abortion harms the mother and father, their families, and the unborn child.” Its mission, as stated in its articles of incorporation, is to “build an abortion-free world.” Conversely, Support Circle indicates on its website, buried in its FAQs, that it doesn’t perform or refer for abortions, and that it’s a Christian organization. Support Circle also asserts that Americans should be “disturbed” and “appalled” by the “high incidence of abortion.”
First Resort was one of many CPCs that paid for Google ads to ensure that they popped up when “abortion” was searched. NARAL persuaded Google to remove the ads after it found that 79 percent of CPCs that purchased advertisements didn’t provide abortion services. NARAL also found that many CPCs don’t disclose their religious affiliation.
Alpha Pregnancy Center operates at 5070 Mission Street. An Evangelical Council for Financial Accountability report on the facility states that it’s a “pro-life center” offering women “alternatives to abortion.” However, Alpha’s website doesn’t identify what services it provides, and doesn’t reveal its religious affiliation.
More than 200 state restrictions on abortions have been enacted over the past six years in both “red” and “blue” states. Clinics in conservative states face hostility from state health departments, which delay building permits. They can have difficulty finding contractors, who are oftentimes stigmatized and boycotted. Oklahoma and Kansas prohibit publicly-funded institutions from performing abortions, which prevents the next generation of medical professionals from learning how to do the procedure as aging doctors retire. In response, the number of abortion providers has drastically fallen. The chances of a clinic reopening or newly starting are small. Nationally, only 21 facilities have opened, while 162 have closed, since 2010.
Bloomberg News reports that just four percent of abortions are conducted in hospitals. These facilities don’t want to tread in politically charged waters, and local governments and religious institutions running hospitals frequently prohibit offering abortions. Likewise, according to Bloomberg News, at least a dozen abortion clinics closed in California since 2011, most of them in the Bay Area. Given that the state has few legal restrictions on abortions, the high number of closures suggests the financial burdens associated with operating a clinic.
San Francisco clinics that offer abortion services or referrals, as well as information about options available to women seeking help during a pregnancy, are Planned Parenthood, the University of California’s San Francisco Women’s Options Center, San Francisco General Hospital’s (USFGH) Women’s Options Center, and the Women’s Community Center (WCC), at 1833 Fillmore Street.
Planned Parenthood has several Bay Area clinics, and is known for its acceptance of whichever path its clients choose. A woman is counseled alone if she comes in with a partner, giving her privacy to convey whatever information she wants to, including disclosing if there’s any pressure to have an abortion.
According to a 2015 Christian Science Monitor article, clients found Planned Parenthood staff to be “nonjudgmental,” and helpful. The Planned Parenthood facility on Valencia Street offers abortion services, birth control options, HIV testing and services, LGBT services – such as hormone therapy – Morning-After Pill emergency contraception, pregnancy testing and services, and sexually transmitted disease testing, treatment and vaccines. It accepts insurance from Anthem Blue Cross Blue Shield of California, Contra Costa Health Plan, Partnership Health Plan of California, as well as Obamacare, but provides services to whomever needs them, whether or not they’re insured, offering a sliding pay scale based on income.
WCC is a nonprofit that operates on a volunteer-based business model. After the Women’s Needs Center of the Haight/Ashbury Free Clinics Inc. closed in 1999, a group of medical professionals and community members collaborated to open WCC a few months later. The center serves any female-identified or female-bodied individual 12 years of age and older who wants health care services, including sexually transmitted illness screening and treatment, birth control, prenatal care, acupuncture, and colposcopy. While it doesn’t perform abortions on site, it provides referrals for abortion services, as well as ultrasounds, alcohol and substance abuse treatment, and mental health services.
The UCSF Medical Center, which manages the Women’s Options Center, is ranked eighth on the U.S. and World News Report Best Hospitals list for 2015-2016; its gynecology department is rated sixth. Operating from 2356 Sutter Street, the center offers abortions, counseling resources, and referrals to other clinics and providers, including WCC. UCSF trains medical professionals in family planning, while conducting clinical research on abortion and contraception. Out-of-pocket prices for women without insurance is $725 for a first trimester abortion, and about $800 for a second trimester abortion.
The Women’s Options Center at USFGH accepts Medi-Cal, and offers an out of pocket price of about $400 for a first trimester abortion.
The abortion pill, or a medical abortion, accounts for 20 percent of abortions nationally. However, according to a Guttmacher Institute study released earlier this year, medical abortions are strictly regulated, with 37 states requiring the clinician performing the procedure to be a certified physician and 17 states mandating that the clinician be physically present during the procedure.