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If you happen to be a pregnant person with questions – say, about the foods you should avoid, how big your developing fetus is or when your morning sickness might finally abate – your online research may lead you to the cheerful and informative website of the American Pregnancy Association. In addition to providing answers to expectant parents, the site offers a wealth of other resources: advice about how to improve fertility, a due-date calculator and even a hotline for pregnancy questions. For those seeking medical expertise about all things gestation-related, the American Pregnancy Association seems to be a one-stop shop. The group describes itself as “a national health organization committed to promoting reproductive and pregnancy wellness through education, support, advocacy, and community awareness.”
Better yet, it seems to be committed to science. “The Association believes that research is the foundation to significant reproductive discoveries,” the site says. Indeed, the group is cited as a source by many respected medical institutions, including the Cleveland Clinic, Los Angeles’ Cedars-Sinai, Boston’s Brigham and Women’s Hospital and Maryland’s Johns Hopkins HealthCare. The New York Times, The Washington Post and CNN have included its advice in articles. The official website about women’s health at the U.S. Department of Health and Human Services links to the American Pregnancy Association as a resource for those seeking information about pregnancy tests. The Office of Child Welfare recommends that parents considering adoption peruse its list of potential questions to ask adoptive parents.
So comprehensive and widely known are the organization’s offerings that it’s easy to overlook the section about unplanned pregnancies, where the tone is decidedly different – fewer facts, more feelings. “If you’re researching your options, you probably need to talk,” the page says, offering a hotline number. “There will be no judgment, no guilt, only a friendly caring person ready to listen and talk.” Actual information about abortion is hard to find, and what the site does provide is sandwiched between warnings. “Consider the impact the procedure may have on your future,” the site advises.
Here’s another thing it doesn’t mention: The American Pregnancy Association isn’t the dispassionate medical authority it might appear to be. Rather, it’s the brainchild of a Texas-based anti-abortion activist named Brad Imler, and it’s rife with medically inaccurate information – on both abortion and other reproductive health topics. The site hawks unproven blood tests, infertility treatments and products purported to support the pregnant person and developing fetus. The American Pregnancy Association presents all of its information and products as evidence-based and medically accurate – but nowhere can one find its activist foundations or learn that it doesn’t have a single medical professional listed on its staff of a handful of people.
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This veneer of medical expertise isn’t a new phenomenon in the anti-abortion movement. Over the last few decades, such groups have built a robust network of crisis pregnancy centers designed to look like doctors’ offices, complete with ultrasound equipment and available nurses. The purpose of these offices is to dissuade people from getting abortions, yet the staff and marketing materials rarely mention this – crisis pregnancy centers’ misleading messaging has been the focus of several recent court cases. The American Pregnancy Association is set up like a virtual version of these crisis pregnancy centers, attracting expectant parents with its promises of need-to-know information – then gently leading them through an experience subtly laid out to discourage abortion at all costs. It’s a highly successful design: Even the abortion-rights think tank the Guttmacher Institute lists the American Pregnancy Association among its sources for information about fetal development.
In the coming years, much of the battle over reproductive rights could play out online: As more states move to criminalize the termination of a pregnancy, trusted clinics are closing and creating an information vacuum, says Sylvia Guendelman, a University of California, Berkeley, reproductive health scholar. “People are going to go online to look for the information because they want the information,” she told me. “This is a pro-life movement that is trying to systematically disinform people.”
Last month, I traveled to Jacksonville, Florida, to learn about how Brad Imler had parlayed his experience as a crisis pregnancy center hotline worker into creating the website of the American Pregnancy Association. Early on a Tuesday morning, I arrived in the lobby of a Hyatt Regency hotel to pick up my badge for the 51st annual conference of the anti-abortion group Heartbeat International. The hundreds of attendees standing in line with me were buzzing with anticipation; they had signed up for sessions including “Why Not Birth Control” and “Healing a Feminist Culture.” Almost all of them were women; the few men in attendance all seemed to be leaders – keynote speakers, presenters, panelists.
At 9 a.m. sharp, 70 other attendees and I took our seats in a conference room and listened intently as Imler, a genial, middle-aged man with an easy laugh, told a few gentle jokes about Jesus and then got down to business. This daylong session was called “The Abortion-Minded Caller.” The business-casual-clad women in the audience, most of whom worked at crisis pregnancy centers, would learn how to turn abortion seekers into clients, an art that Imler had perfected over the last 25 years. “When she calls or comes into your center, that’s a divine appointment,” Imler told them, almost whispering. “God has chosen you to work with her.”
Imler recounted how, as a college student in the 1980s, he had paid for his girlfriend’s abortion. So racked with guilt was he in the days that followed that he promised God he would do “anything, anytime, anywhere for the cause of life.” A decade later, with a Ph.D. in psychology and a master’s degree in social work under his belt, Imler took over the American Pregnancy Helpline, one of the first hotlines set up to persuade pregnant people not to have abortions. Over the following years, he honed his skills of persuasion and strategies of engagement.
The audience took notes as Imler doled out his top tips. Ask open-ended questions to get her talking. The correct answer to, “Do you do abortions?” is not “no” – at least not at first. It’s: “So you’re seeking information about abortion; how have you confirmed your pregnancy?” If she mentions abortion again, the response should be, “Which risks of abortion concern you the most?” Impress upon her the need to come into the office for an ultrasound or other tests because “the more medical you are, the more respected you will be.”
The truth was that some parts of the conversation were just tricky and did not lend themselves to empathic evasion. Eventually, you had to deliver the bad news that your clinic wouldn’t actually be performing the abortion that the caller was seeking. Members of the audience debated strategies for delicately dropping this bomb. “We have a service called ‘pre-termination,’ ” offered one. “I like that terminology,” said Imler, nodding approvingly. Another attendee wasn’t so sure; she thought it sounded deceptive.
After lunch, we split into pairs to do a role play. My partner was a friendly older woman from New Jersey who admitted to me that the exercise made her nervous, in part because she felt self-conscious about her accent – she usually took calls in her native Spanish. I played the role of the counselor first and dutifully went through the script that Imler had taught us. I was doing pretty well until the part where I was supposed to let the caller know that the clinic wouldn’t actually perform an abortion, but I would still try to persuade her to come in for an ultrasound. “Ah, well, abortion might be a choice that you make down the road,” I ventured, “but before doing that, you’re going to need to, uh, get some more information.”
My partner did a better job when it was her turn to play the clinic worker. “It will be very beneficial for you to get an ultrasound for free,” she told me kindly. “We can counsel you on additional procedures, so you might know more about the rules. We can do a pre-termination consultation. Would you like to do that?”
“Oh, that sounds really good,” I said.
My partner smiled. “Let’s set up an appointment for you, my dear.”
When Imler took over the American Pregnancy Helpline as a young Christian social worker, he said, the hotline served about one caller a day. “I wrestled with God, and I confess to you this was pride,” he recalled. “I said, ‘God, can’t you use me for something more?’ ”
God answered his prayers, giving him the idea for a website that would work like the hotline, but reach many more people. In 2003, the American Pregnancy Association was born. Just a few years later, “We were No. 1 for pregnancy symptoms, signs of pregnancy. Anything that was related to ‘Am I pregnant?’ we were No. 1.” He looked at the crowd. “And we had 800,000 women a month on our pregnancy-symptoms page using our ZIP code search to find you.”
Imler ran the American Pregnancy Association until 2019, when he stepped down to found a Christian adoption agency. The group has a new president now, a marketing veteran named Lynn Handley, who said in an email that Imler is no longer involved with the group. Its website is still going strong: According to its nonprofit tax filings, in 2021, more than 6 million people visited the website in a single month – impressive, especially considering the group’s modest budget of just shy of $400,000 in revenue, almost all of which came from the corporate sponsors whose products the site featured. In a 2021 study, a group of public health researchers at the University of California, Berkeley, found that the American Pregnancy Association was the second-most-common website in Google searches for information about the abortion pill, second only to Planned Parenthood.
The greatest challenge in engaging with abortion-minded callers on a hotline is that simply memorizing a script won’t really work. Each situation is unique, and there is no way to predict the conversational twists and turns. The American Pregnancy Association website offers a neat solution to this phone problem, expertly leading users down a carefully curated path. Click on the “unplanned pregnancies” section, and you’ll be directed to a page advertising a support group called Embrace Grace. “Goodbye fear, hello joy,” the accompanying text says. The page on options for unplanned pregnancies gently encourages users to consider parenting and adoption before considering “the final option.” The site implores those considering abortions to first ask themselves questions like, “Is this ‘choice’ for convenience’s sake?” and “What do I know about the potential negative emotional impact of having an abortion?” and “Am I aware of the relationship between abortion and breast cancer?” (It doesn’t mention that scientists agree that there is none.)
For the persistent few who still want to know about abortion, there’s a page on the topic that seems straightforward enough, listing the types of procedures along with their risks, including “problems breathing” from anesthesia, infection, scarring and “accidentally putting a hole in the uterus with one of the instruments used.” At no point does the site indicate the frequency of these terrifying outcomes – which, according to the American College of Obstetricians and Gynecologists, are all rare. The risk of damage to the uterus, bowel or bladder during a surgical abortion is less than 1 in 1,000 even during the second trimester, about half that of dying from an appendectomy.
Should someone be among the increasing number of people who opted for a medication abortion, the site says, it’s still possible to change things even after the first pill has been ingested. It touts a new and medically dubious procedure called abortion pill reversal that involves taking a high dose of the pregnancy hormone progesterone. Most medical groups don’t endorse this protocol; the American College of Obstetricians and Gynecologists said in a statement that its safety and efficacy “are not based on science and do not meet clinical standards.” The American Pregnancy Association admits that the abortion pill reversal “is not necessarily FDA approved” but notes, somewhat cryptically, that “it is still used without legal issues.”
Sprinkled throughout the site are endorsements for products masquerading as expert pregnancy advice. In the fertility section, readers are encouraged to purchase a special ovulation monitor, while elsewhere they can find an at-home test for sperm viability. The page on gender prediction is actually a thinly veiled ad for yet another new test, boasting, “With a small blood sample, now you can determine if pink or blue is in your future with 99.5% accuracy!” The section on nutrition during pregnancy offers a page hawking an ice cream line called Nightfood, whose manufacturers claim it’s specially designed to satisfy the nocturnal cravings of pregnancy, plus: “It’s sleep expert and crave monster approved, and now American Pregnancy Association recommended. Place an order today!”
Lynn Handley, the current president of the American Pregnancy Association, said in an email that the products recommended on the site “are not required to be FDA approved as they are not intended to diagnose, treat, cure or prevent any disease” and that “a nurse and executive team review testing results, case studies and other data before we consider endorsing or including a product in an article.” Handley noted that the abortion pill reversal drug that the site recommends “is based on protocols to support pregnancies” and has “been a standard protocol for decades” when a woman experiences a miscarriage or is going through in vitro fertilization. (The key difference that Handley doesn’t mention is that in the case of miscarriage and IVF, the progesterone protocol has been studied – while in the context of abortion pill reversal, it has not.)
Put simply, the American Pregnancy Association omits key statistics, offers medically questionable advice and hawks products – while being richly rewarded with robust web traffic and links from premier health institutions and the federal government. All this would be unsettling enough on its own, but it also plays an important role in a much bigger ecosystem of online health disinformation. Taylor Agajanian, a disinformation researcher at the University of Washington, saw parallels with the thriving anti-vaccine movement. The activists she studies exaggerate the frequency of rare side effects, insist on the efficacy of unproven COVID-19 treatments such as ivermectin, and use their platform to sell supplements, essential oils and other wellness products. These tactics are extremely effective at reaching people who are “actually very scared,” Agajanian says. “They’re doing what they are being told is going to help them.”
And there are likely a lot of them, says Betsy Pleasants, one of the UC Berkeley researchers who studied the prominence of the American Pregnancy Association in Google search results. “The implications of that are pretty substantial when you think about the number of users that might be accessing and interacting with the information,” she said. Not to mention how they’re interacting with the information. In the wake of Texas’ recently enacted “heartbeat bill,” which prohibits abortion after a fetal heartbeat is detected, there was a flurry of media coverage about the precise point at which human cardiac activity begins. One of the most commonly cited sources in the local press? The American Pregnancy Association.
It’s not surprising that the loudest and most disruptive anti-abortion activists receive the most national attention – the protesters outside clinics, for instance, or the legislators narrowing the window within which a pregnant person can end a pregnancy. But there is a quieter and more intimate part of the movement, too – one that has the potential to profoundly affect countless individual lives. That is Imler’s specialty: the part that takes place on hotline phone calls, in crisis pregnancy center offices and in late-night Google searches.
At the end of the training day, some intrepid audience members volunteered to do role plays in front of the whole group. One young woman hammed it up as a self-obsessed mom of two who didn’t want to ruin her figure by getting pregnant again. She had great comic timing. Although this took place at the end of a seven-hour training, the audience was full of energy, calling out suggestions to the woman playing the counselor and roaring with laughter. When the session was over, the ladies spilled out of the room, sizzling with conversation and maybe even a sense of purpose and belonging. They exchanged contact information, some planning to meet up for drinks later, others promising to stay in touch after the conference ended.
This softer, user-friendly approach to anti-abortion activism is Imler’s preferred style. He told us that he attends the conference of the American College of Obstetricians and Gynecologists every year and that he is dismayed by the lurid tactics of some of the anti-abortion protesters he sees there. “The big buses and things that have pictures of aborted fetuses, and the ‘you’re going to hell’ and all of this, I can’t stand it,” he told the trainees. Instead, he believes in engaging with the “other side,” the abortion rights movement. “I personally don’t even think they’re enemies. I want to have conversations with them.”
Apparently, reporters fall into a different category. When I reached out to Imler a few days after the conference to see if he’d be up for a phone call, he was decidedly against the idea. In response to my questions about his history with the American Pregnancy Association, he demurred and suggested I reach out to Lynn Handley. She told me in an email, “People find APA because they have a question, ‘am I pregnant,’ ‘how do I get pregnant,’ ‘is this bleeding normal?’ When they search a question on Google or other search engines one of our source-cited articles may appear.” The overall goal of the site, she wrote, “is to provide unbiased information about all considerations, including abortion methods and side effects, as well as other options.” She added, “Wouldn’t you agree they are entitled to that information?”
Just before Imler stopped responding to my emails entirely, he returned one of my messages with something that read like a very short personal mission statement. The centerpiece of his work was “figuring out her ‘What ifs’ and what can be done to meet them,” he wrote. “Making sure she has all the information she needed in making her decision is my focus.”
Students at UC Berkeley’s Investigative Reporting Program and Human Rights Center contributed additional reporting in collaboration with Reveal from The Center for Investigative Reporting: Eleonora Bianchi, Elizabeth Moss and Eliza Partika.