Dr. Kristyn Brandi is concerned about the number of patients coming into her office with bad information and a look of confusion.
They often come to Women's Choice Medical Center, the health clinic where Brandi serves as medical director, after initially going to a crisis pregnancy center they thought offered abortion care.
"People will come with their ultrasound images from these places, which are often not done by trained monographers, so I'll look at those pictures and say, 'I'm sorry, I don't know what I'm looking at,'" said Brandi, a board-certified OB-GYN and abortion provider.
Sometimes the ultrasound picture will have the words "baby" or "heartbeat" written on it with an arrow to where the baby supposedly is, said Brandi. The intentional emotionally charged language is alarming, she said. But of even greater concern to Brandi is the safety of patients who go to these anti-abortion facilities.
"Other providers have told me about women that find out they're later in pregnancy than they thought they were, or they have an ectopic pregnancy when they were told everything was fine," said Brandi. "And of course, the patient is so confused in the middle of it. They come in with information from people wearing white coats that they thought was accurate. It's annoying most of the time and potentially dangerous at others."
It's easy to see how a patient could be misled. A Google search for "abortion centers New Jersey" will yield sponsored ads for nearby "pregnancy care centers" or "crisis pregnancy centers." Their websites urge women considering an abortion to schedule an appointment with them first for services like free pregnancy testing, ultrasounds, STD testing, and even "abortion info consultation," even though they don't perform abortions.
In fact, critics say they may try to dissuade patients from getting one by giving false information, such as claiming a pregnancy is further along than it is, exaggerating the dangers of abortion, and promoting the unproven "abortion reversal pill."
And that's just part of the problem, according to the state attorneys general and legislators waging a battle against the facilities which began nearly two years ago with a series of consumer alerts warning residents seeking reproductive healthcare to avoid crisis pregnancy centers. Now, a legal fight is playing out in the courts as the state investigates a religious non-profit for deceiving the public over abortion access, and the group pushes back in defense of its religious rights.
Since the Dobbs decision which overturned Roe v. Wade, the landmark case that protected the right to abortion for nearly 50 years, 14 states have enacted near-total abortion bans and an additional six have passed restrictions, according to the Kaiser Family Foundation for health policy research.
As abortion access has become more restricted in the country, funding for such centers has increased. In the last two years alone, nearly $500 million in taxpayer dollars has been allocated to these centers, according to research compiled by Equity Forward, an abortion-rights watchdog organization.
According to new research, there are nearly 3,000 anti-abortion centers in the United States, three times the number of abortion clinics in the country. Despite evidence of mismanagement and criticism of centers' methods, the House passed a bill earlier this year that would pave the way for anti-abortion centers to receive federal funding.
But it's not just anti-abortion states where a legal battle is unfolding. It's happening here, too -- a state known for its stalwart protection of abortion rights. There are 59 of these anti-abortion facilities, nearly twice the number of medical clinics that perform abortions.
"The fight for life is intensifying in New Jersey. Pro-abortion groups are stronger than ever, and PRCs (pregnancy resource centers) face unique challenges," according to the New Jersey Association for Pregnancy Centers' website.
The nonprofits known as crisis pregnancy centers are often nonclinical facilities that advertise counseling and support for women experiencing unplanned pregnancies.
The centers and their supporters say they provide necessary services and resources to women and families in need. In New Jersey, that meant an estimated $3.6 million in services to more than 23,000 women, men, and youth, according to a 2022 report from the Charlotte Lozier Institute, an anti-abortion think tank, and Care Net, a Christian organization that supports 1,200 centers in North America.
"The women who come to us come often because they're unsure about what they're going to do in their pregnancy. We exist to provide compassionate care, including pregnancy tests, medical confirmation via ultrasounds, we have a parenting program, we have a whole range of services," said Aimee Huber, Executive Director of First Choice Women's Resource Center, a Christian nonprofit with five locations in New Jersey.
New Jersey does not provide funding to such centers. Quite the opposite, in fact. State lawmakers have written letters to the U.S. Department of Health and Human Services asking it to stop the flow of federal dollars to pregnancy centers, and Democratic Gov. Phil Murphy has signed bills that enshrine the right to obtain an abortion, including for out-of-state residents traveling to New Jersey.
The consumer alert issued by the Attorney General's Office and the Division of Consumer Affairs two years ago accuses pregnancy centers of seeking "to prevent individuals from accessing abortion care, sometimes by providing false or misleading information about the safety and legality of abortion."
"Under Governor Murphy's leadership, our state is deeply committed to protecting the rights of those who provide and receive reproductive services, and our office will continue to use every available resource to protect access to abortion care here in New Jersey," said Matthew J. Platkin, then-acting Attorney General, in a press release.
First Choice Women's Resource Center, one of the largest anti-abortion nonprofits in New Jersey, has found itself in the state's crosshairs and claims they're being unfairly targeted by government overreach.
Shortly after the consumer alert was issued, attorneys for a group of pregnancy centers requested records from the Attorney General's Office seeking information on investigations, emails, and other records that drove officials to issue the alert. When they were denied, the consortium sued.
Ultimately, a judge ordered the Attorney General's Office to produce most of the documents and pay the majority of the group's legal expenses. Anti-abortion groups declared this a legal victory, but Platkin has remained undeterred in trying to hold pregnancy centers accountable for allegedly spreading misinformation.
The state issued a subpoena against First Choice in November 2023 seeking a broad range of documents going back more than 10 years, saying it was believed First Choice was deceiving its donors by running multiple websites, that it was conducting medical procedures without the proper licensing, and sharing medical information that may be misleading. Additionally, the state said First Choice represents that its services are "confidential" and "private" but elsewhere, it claims that it is exempt from HIPAA because it does not accept insurance, raising patient-privacy concerns.
Attorneys for First Choice sought to put a halt to it by filing a federal lawsuit claiming that the state offices were attempting to chill free speech. That move was shot down, but an appeal is pending.
The organization is actively fighting attempts to enforce the subpoena in state court.
"We have a state official punishing one side of the debate for its views and targeting it with an invasive and prejudicial demand for its donors," said Lincoln Wilson, an attorney with Alliance Defending Freedom, the Christian legal advocacy group representing First Choice.
"We're standing up," said Wilson. "This is not a case about abortion. This is a case about the First Amendment."
The state says otherwise.
"The subpoena is motivated by concerns about First Choice's potential factual misrepresentations and omissions and other conduct, not by First Choice's religious beliefs or statements," it said in court papers.
Assemblyman Paul Kanitra is calling for the state legislature or even the federal government to investigate the Attorney General's motives for pursuing an investigation into First Choice and other pregnancy centers.
"Platkin is using the courts to cripple pregnancy resource centers into oblivion, plain and simple," Kanitra said in a statement. "It's a pregnancy resource center. They offer screenings and counseling just like Planned Parenthood does. They don't offer abortion referrals and services, just like Chick-Fil-A doesn't sell hamburgers. Sane people know this."
First Choice is "very upfront" about the services it does and doesn't provide, said Huber.
"All of our advertising states clearly that we do not perform or refer for abortions, starting with our website," Huber said. "And then if a woman contacts us via text or phone she is quickly told if she is interested in abortion at all that we do not refer for that procedure or perform it."
People calling for increased regulation of pregnancy centers disagree that they are upfront about their intended purpose. In fact, critics allege the centers -- not just First Choice -- purposefully mislead women into thinking they offer abortions and try to talk patients out of exercising their right to abortion.
"Women go to these healthcare hoax clinics thinking they'll get real medical help and care but instead they're greeted by people with no medical background whose goal is to brainwash women with their own extreme ideological agendas," said U.S. Rep Josh Gottheimer, D-5th District, during a press conference last year calling attention to pregnancy centers' "deceptive tactics."
A study by the Alliance for Women's Rights and Gender Equality of 607 anti-abortion centers across nine states found that almost two-thirds of anti-abortion centers "promoted patently false and/or biased medical claims about pregnancy, abortion, contraception, and reproductive health care providers." Additionally, fewer than half reported having a licensed medical professional on staff.
Last year, Gottheimer sponsored the Stop Anti-Abortion Disinformation Act that would require the Federal Trade Commission to prohibit misinformation and disinformation related to abortion services and authorize the FTC to penalize organizations that break this rule. The bill was introduced, but never made it past committee.
Gottheimer said he's spoken with women who visited pregnancy resource centers and "have told me of their experiences where they are brought in there and not given the facts."
"You can't make women feel they're going in and getting medical support and advice and then leave out the major headline, 'We will never refer for an abortion in any case, even when the health of the mother is on the line,'" said Gottheimer.
Anti-abortion centers and abortion clinics can be hard to tell apart, according to a 2021 study that used screenshots of both types of facilities to see if women could determine the difference. They may have a name similar to that of a nearby abortion clinic, including words like "care," "health," "pregnancy," "resource," and "choice." They may even have similar websites with pictures of people wearing lab coats and stethoscopes.
Women who call anti-abortion centers might have a hard time getting a clear answer as to whether or not the facility provides abortion, critics say.
"We are a good place to start if someone is looking for an abortion because we do provide the first steps at no cost," said a friendly receptionist who picked up the phone for First Choice pregnancy centers in October.
The woman said they provide ultrasounds to determine if the pregnancy is viable and also "abortion options consultation," though, "not available specifically at our center as we don't provide the procedure here."
When asked to clarify, the receptionist said, "We don't provide the abortion procedure but we do help with the first steps if someone is looking to get an abortion, if someone is looking to medically confirm the pregnancy."
"I think the confusion is the point," said Brandi, the medical director at Women's Choice Medical Center. "I have patients who went to a place that had 'choice' in the name and they thought they could get abortion care there."
"I think the general sense I get from patients who've gone to these places is that they feel they've been lied to and it creates this air of distrust," said Brandi, former board chair for Physicians for Reproductive Health.
"There's a lot of attention, rightfully so, on the deceptive tactics of a lot of these centers," said Betsy Armstrong, an associate professor of sociology and public affairs at the Princeton School of Public and International Affairs. "It's clear some people think they are going somewhere like a Planned Parenthood."
Where they choose to open up isn't coincidental, some studies. Two-thirds of New Jersey's 21 Planned Parenthood health centers have an anti-abortion center operating within three miles of their location and half have an anti-abortion center within one mile, according to a Planned Parenthood Action Fund of New Jersey report.
The centers have also been described as unethical by leading professional medical organizations, including the American Medical Association, the American College of Obstetricians and Gynecologists, and the American Society for Reproductive Medicine.
They say some facilities share incorrect statistics about whether women regret having an abortion and false, and potentially harmful, information about the efficacy of the "anti-abortion pill."
The tactics used by pregnancy centers aren't just unethical, said Armstrong, they fly in the face of reproductive justice and personal bodily autonomy.
Reproductive justice is a framework in which every person has the "right not to parent, the right to parent, and the right to parent the children you have in safe and sustainable communities," said Armstrong.
"Many people who look at the anti-abortion centers, not from the center itself, would be concerned by the level of deception or coercion involved. The interaction is counter to what we think of as reproductive justice because it's trying to influence someone's decision in a particular way and not being open to all the potential resolutions of a pregnancy."