On a sunny October afternoon, a young woman exits the Planned Parenthood office in Napa carrying a small white paper bag. She hasn’t taken more than five steps toward her car before she’s approached: “Hi, can I give you some information about free resources?”
It’s the Friday before Halloween of 2022, four months after the Supreme Court issued its landmark decision that overturned Roe v. Wade, leading to bans on most abortions in about 13 states (so far). It’s about a week before the midterms, when California voters will decide to enshrine the right to an abortion in the state constitution.
But today, here in Napa, the abortion conversation looks like this: A woman named Teresa Conemac sits on a stool steps away from the Planned Parenthood entrance, wearing scrubs and a badge that reads “client advocate,” praying and performing what she and her fellow volunteers with the Christian anti-abortion organization 40 Days for Life call “sidewalk counseling.” She talks to people approaching or exiting the clinic, and gives them pamphlets featuring widely debunked claims about the dangers of abortion and birth control. Conemac also tells them about resources at, and distributes cards for, the facility next door: the Napa Women’s Center, opened by the Christian nonprofit Napa Valley Culture of Life in 2020. No medical professionals work at this facility, but a visitor can take a free pregnancy test, learn about adoption agencies and pick up pamphlets that inaccurately link abortion to breast cancer, infertility, depression and death.
The Napa Women’s Center is an anti-abortion center — sometimes known as a “crisis pregnancy center.” It’s one of approximately 3,000 such facilities across the country. Established by faith-based organizations, anti-abortion centers exist primarily to dissuade people from having abortions. They often attract clients by opening in close proximity to abortion care clinics and by advertising reproductive health services, despite the vast majority operating without medical licensing.
In Napa, it is no accident that an anti-abortion center operates right next to the city’s lone Planned Parenthood, in a state of uneasy tension, on one small city block. Connected by a 6-foot wooden fence, their facades are plain, and notably similar to the casual observer.
But behind those doors lie two vastly different worlds. For a pregnant person seeking health care, the choice of which one to enter comes with potentially life-changing consequences. None of the new state laws aimed at strengthening abortion rights can help a patient who’s standing on the sidewalk outside, deciding between the two, confused about what they’re seeing. And as long as California fails to regulate anti-abortion centers, advocates say, calling itself a sanctuary state won’t change a thing about that.
‘We don’t have a moment to lose’
Anti-abortion centers have existed in some form since the late 1960s, when Catholic activists first sought to counter the growing legalization of abortion in the United States. After the U.S. Supreme Court ruled that the right to an abortion was protected by the Constitution in its 1973 Roe v. Wade decision — which, had it been upheld, would have celebrated a 50th anniversary Jan. 22 — the so-called crisis pregnancy center movement expanded to include evangelical Christians. That expansion led to networks like Heartbeat International, which operates more than 2,000 centers worldwide.
Anti-abortion centers proliferated throughout the ’90s and aughts, in part thanks to federal grants for abstinence-only education under President George W. Bush; many received further federal funds due to changes made to Title X under the Trump administration. In 2019, for example, the California-based network of centers calling itself Obria Medical Clinics — which operates in Oakland, Redwood City, Union City and San José — was awarded $5.1 million over three years by the U.S. Department of Health and Human Services.
But with the fall of Roe, abortion-rights advocates say these centers have assumed an even more powerful role in the landscape, becoming an increasingly valuable tool in the anti-abortion movement’s arsenal. At the same time, advocates charge, anti-abortion centers only intensify the inequities in abortion access along racial and socioeconomic lines.
These centers’ impact might be most dramatic in the 26 states that either recently banned or plan to heavily restrict abortions, where even seeking out abortion information could put a pregnant person on the wrong side of the law. But advocates say anti-abortion centers also play a surprisingly significant role in blue states like California, where they outnumber clinics that provide abortions by 20% — and where as many as 16,000 people are now expected to travel each year in search of abortion care (PDF).
“This is one of those issues where time is of the essence to the women who are involved, whose lives are at stake,” says former Los Angeles City Attorney Mike Feuer of the lack of regulation around anti-abortion centers. “And because of what’s happening nationally, we don’t have a moment to lose.”
In his last months as city attorney in 2022, Feuer successfully introduced a city ordinance that makes it punishable by up to $10,000 for a facility to “mislead women into believing they offer a full range of reproductive health services, including abortion or abortion referrals” when they do not.
“We may already be in a situation where women who are utterly desperate to exercise their full reproductive choices are coming to our city,” says Feuer. “And we need to ensure that when they do, no pregnancy center misleads them about their services and what their options are.”
‘Working at medical facilities, we have so many regulations on everything we do. But then these places that are not medical facilities — that are disguising themselves as medical facilities — are totally unregulated? It makes no sense.’
Christine Henneberg, Bay Area OB-GYN and author
Going unmentioned in LA’s new ordinance is how difficult it’s proven to regulate these facilities — Democratic lawmakers have been trying, and mostly failing, for years. Most recently, California’s 2015 Reproductive FACT Act required reproductive health care facilities to inform clients about the state’s programs that provide low-cost or free contraception and abortion, and forced unlicensed centers to post notices acknowledging that they were not licensed health care providers.
In 2018, after the law was challenged by an anti-abortion legal organization, the U.S. Supreme Court voted 5–4 to strike it down on the grounds that it violated the First Amendment.
For Christine Henneberg, a Bay Area OB-GYN and abortion provider — who says “a fair number” of her patients have interacted with an anti-abortion center by the time they land in her office — the continued lack of regulation is “absurd.”
“Working at medical facilities, we have so many regulations on everything we do,” says Henneberg. “But then these places that are not medical facilities — that are disguising themselves as medical facilities — are totally unregulated? It makes no sense.”
Absent meaningful regulation, some agencies have focused on education: In June of 2022, California Attorney General Rob Bonta issued a consumer alert about anti-abortion centers. And the state’s new hub for abortion resources, abortion.ca.gov, includes a section on how to spot the differences between such centers and legitimate clinics that offer abortion care.