Spatial Analyses of Crisis Pregnancy Centers and Abortion Facilities in the United States, 2021: Pre-Dobbs Cross-Sectional Study (Preprint)

Abstract

Background: Crisis pregnancy centers (CPCs) are religious non-profit organizations that have a primary mission of diverting people from having abortions. For decades, one tactic used by CPCs has been to locate near abortion facilities. Despite medical groups' warnings that CPCs do not adhere to medical and ethical standards and pose risks to individual and public health, government support for CPCs has significantly increased over the past decade.Objective: This study aimed to map CPCs, abortion facilities, and geographic areas in the United States (US) categorized into four zones defined by their proximity to CPCs and abortion facilities in 2021. We also sought to describe the number and percentage of reproductive-aged women living in each zone and the proximity of CPCs to abortion facilities. Methods:Using 2021 data from CPC Map and the Advancing New Standards in Reproductive Health (ANSIRH) Abortion Facility Database, we determined the ratio of CPCs to abortion facilities. Using these sources and Census data, we categorized and mapped US block groups into four distinct zones based on the locations of block group centroids within 15-mile radii of CPCs and abortion facilities: 1) no presence, 2) CPC only, 3) abortion facility only, and 4) dual presence. We used summary statistics to calculate the number and percentage of block groups and reproductive-aged (15-49 years) women living in each zone. We also calculated distances and drive times from abortion facilities to the nearest CPC. All analyses were conducted nationally and by region, division, and state. We used chi-square statistics to test for differences by region and division in the number of block groups and women classified to each zone.Results: Nationally, the ratio of CPCs to abortion facilities was 3.4, and 55% of block groups were categorized in the "dual presence" zone, 27% as "CPC only," and 0.8% in the "abortion facility only" zone. Most (60%) reproductive-aged women lived in a "dual presence" zone, 26% in a "CPC only", and 0.8% lived in an "abortion facility only" zone. We detected statistically significant variations (p<0.001) in the number of block groups and women classified as living in each zone by region and division. Nationally, the median distance from abortion facilities to the nearest CPC was 2 miles, and the median drive time was 5.5 minutes. Minimum drive times were <1 minute in all but 11 states. Conclusions:The findings suggest that CPCs' tactic of locating near abortion facilities was largely realized before the 2022 US Supreme Court decision that overturned the federal right to abortion. Research on CPCs' locations and tactics should continue given the dynamic abortion policy landscape and risks posed by CPCs. Tailored programming to raise awareness about CPCs and help people identify and access safe sources of healthcare may mitigate harm.