The Anti-Abortion Movement’s Digital Strategies to Track Pregnant Women

While all eyes are on the Supreme Court as it debates overturning Roe v. Wade, the anti-abortion movement is developing ever-more sophisticated digital strategies to reach and track pregnant women in order to impede their access to reproductive health services and stop them from having abortions.

Anti-abortion “crisis pregnancy centers” (CPCs) masquerade as medical clinics, collecting vast troves of confidential information from pregnant women — with little transparency or accountability. Today, there are approximately 2,500 CPCs in the U.S. (in comparison to just 800 or so abortion clinics). And, they appear to have the capability to share clients’ confidential information with global anti-abortion networks seeking to stop abortion.

Reproductive rights advocates fear that crisis pregnancy centers — as the eyes and ears of the anti-abortion movement — could play a key role in state enforcement of abortion bans that are likely to be enacted in more than half of states if Roe v. Wade falls.

“The CPC industry is positioned to surveille pregnant people and feed the data they’ve collected to vigilante anti-abortion bounty hunters where there are SB8-type laws and to law enforcement where there are outright abortion bans in a post-Roe world,” says Jenifer McKenna, program director at The Alliance, a collaboration among five regional women’s rights and gender equality advocacy centers.

CPCs Use Deceptive Tactics to Collect Private Medical Information

Privacy International — which advocates for data privacy — has documented that crisis pregnancy centers collect personal information about pregnant women, such as name, address, email address, cell phone number, ethnicity, marital status, living arrangement, education, income source, alcohol use, and cigarette and drug intake. CPCs also collect private medical information and history, including about medication use, sexually transmitted infections, pregnancies, medical testing, and ultrasound photos.

Pregnant women share this private information believing it will be kept confidential under medical privacy laws such as HIPAA. And why wouldn’t they? CPC volunteers wear white lab coats, ask the kinds of questions doctors and nurses often ask patients in medical settings, and offer pregnancy tests and “nondiagnostic ultrasounds.” But in fact, the vast majority of crisis pregnancy centers are not required to follow state or federal medical privacy laws.

“This is a major risk that most people are not aware of,” says Kim Clark, senior attorney at Legal Voice, a women’s rights advocacy organization in Seattle. “Crisis pregnancy centers for the most part are not health care facilities. They’re not providing real medical services. And they’re not subject to HIPAA. But they’re collecting all kinds of personal information from folks who believe that they’re going to a medical facility where their personal health information will be kept confidential like at any other health care facility.”

As nonprofit advocacy groups that do not offer medical services or charge visitors, crisis pregnancy centers are not subject to medical licensing requirements, nor are they subject to consumer protection laws. In fact, the Supreme Court in NIFLA v. Becerra ruled that crisis pregnancy centers have a First Amendment free speech right to hide the fact that they are not licensed medical clinics.

CPCs often have deceptive privacy policies on their websites, many referencing HIPAA. “They are claiming to be HIPAA compliant, when they’re actually not,” says McKenna.

“Even as a lawyer, it took time for me to parse through what they’re talking about,” says Clark, who describes CPC privacy notices as often “confusing” and “conflicting.”

Thrive Women’s Clinic in Dallas, for example, has a privacy policy that allows them to disclose private client information “to avert a serious threat to the health or safety of you or any other person pursuant to applicable law.” In light of the anti-abortion belief that fetuses are persons with the full rights of citizens, this provision may be interpreted as essentially authorizing them to share private medical information with anyone.

Regardless of their privacy claims, CPCs are under no legal obligation to follow through on their promises of confidentiality, says Clark. “There are no legal protections to ensure that your private information is not shared, not only within the crisis pregnancy center, but even beyond with third parties, for marketing purposes, for political purposes, for movement-building purposes, or for fundraising purposes. They may make assurances that they’re keeping information confidential, but there are no laws that require them to do that. There is a serious lack of guardrails.”

CPCs have used the information they obtain from patients to harass and punish them for having abortions, says McKenna. “A practice CPCs use, and one of the ways that they violate people’s private information, is to contact them without their permission after they’ve been to the CPC. They harass them by phone and text,” says McKenna.

In one case, a pregnant woman in New Mexico visited a CPC, then ended up finding an abortion provider and having an abortion. But the CPC continually called her trying to get information about her abortion. They even called her mother, whom she had listed as an emergency contact on the forms she filled out at the CPC. “She didn’t authorize them to be in touch with her [mother],” says McKenna.

To better understand the impact of CPC data privacy violations, the investigative news organization Reveal recently launched a survey for people who have shared personal information with a CPC.

But what concerns reproductive rights advocates even more than the deceptive collection of information from pregnant women is that CPCs may be sharing that information with large organizations in the anti-abortion movement.

CPC Industry Deploys Advanced Digital Strategies to Share Women’s Private Information

When pregnant women agree to share their information with CPC volunteers, many do not realize their local CPC is affiliated with global anti-abortion organizations with which their information may be shared.

Four anti-abortion organizations dominate the global CPC industry — Heartbeat International, CareNet, Obria, and the National Institute of Family and Life Advocates. They “tag team in directing key CPC tactics, including digital tactics, and promote them industry-wide,” says McKenna.

To facilitate the sharing of private patient information, the CPC industry has developed sophisticated data technology platforms to collect, share, and access client information, such as eKYROS and Next Level Center Management Solution, according to Clark.

Next Level was developed by Heartbeat International, which markets the software to their 700+ pregnancy center affiliates. On their website, Next Level boasts that its software enables CPCs to access clients’ private information and share it with the broader anti-abortion movement.

Under the tagline “better together,” Next Level explains: “The data your organization collects needs to work not just for you, but for the rest of the pregnancy help movement ...you need to use your own data to make great decisions at the local level. But how much better decisions could you make if your data was part of a robust pool [of] data that serves the whole movement, who are pulling on the same rope together?... Big data is revolutionizing all sorts of industries. Why shouldn’t it do the same for a critical ministry like ours?”

“Large anti-abortion organizations are using crisis pregnancy centers to collect vast amounts of personal information about pregnant people and are positioned to use the big data they are collecting, without oversight or accountability,” says McKenna.

Collecting client data at brick-and-mortar centers, however, is just one of many avenues used by the CPC industry to amass big data on pregnant women. Privacy International has documented a wide range of other tactics as well, including online chat services that collect and share users’ private information, period trackers and other smart phone apps that collect and share information about people’s menstrual cycles and reproductive health, and geo-fencing to tag and target anti-abortion ads to the phones of people inside reproductive health clinics.

The CPC industry even has specialized marketing companies to do this, such as “Choose Life Marketing,” which offers a range of state-of-the-art digital strategies to reach pregnant women and girls.

While reproductive rights advocates do not know what the anti-abortion movement is doing with the “granular digital data” they are collecting about pregnant women, McKenna worries what they might do with it.

“It’s a perfect storm for violations of people’s privacy rights by CPCs in order to support a vigilante, anti-abortion legislative and policy agenda,” says McKenna, especially at a time when states are banning abortion and the Supreme Court is poised to abolish constitutional abortion rights.

Senior research analyst Kara Mailman at the reproductive rights organization ReproAction is worried that CPCs could release confidential information for civil or even criminal prosecutions for abortion.

“When you enter into an agreement with Heartbeat International and you give them your information, there’s a clause that basically says ‘we won’t share your information, except when it advances the mission of Heartbeat International.’ OK, so what does that mean?” asks Mailman. “Part of Heartbeat International’s mission is to end abortion. So does that mean that if Heartbeat International gets a client who has recently had an abortion in a state like Texas, does it advance their mission to release this person’s information?”

Reproductive Rights Advocates Call for Stronger Privacy Protections

Advocates say the CPC industry takes advantage of legal loopholes in privacy laws. “The real problem is a major gap in the law here,” says Clark. “There is nothing in the law to hold them accountable to maintain the privacy of that information.”

So reproductive rights advocates are calling on policymakers to increase oversight and accountability of the CPC industry. McKenna urges lawmakers to “extend HIPAA-like protections to people served by nonprofits providing pregnancy-related services and require providers of pregnancy-related services not covered by HIPAA or other privacy laws to inform clients whether and how they aggregate personal information and how they use it.”

We better act now, says McKenna, because “CPCs are using digital strategies and tools of the 21st century to restrict reproductive choice and roll back people’s rights into the 1950s and 1960s.”