A sign reads: “Unexpected pregnancy? Free testing & counseling.”
A sign outside an anti-abortion crisis pregnancy center in Massachusetts advertises free pregnancy tests. Credit: Pat Greenhouse/The Boston Globe via Getty Images

A state lawmaker is calling for Kentucky to regulate anti-abortion crisis pregnancy centers after a Reveal investigation found that most centers aren’t subject to the same kind of oversight as other medical clinics, even though they perform procedures that can dramatically affect the lives of pregnant people.

The Kentucky bill is among a wave of efforts by reproductive rights advocates in more than a dozen states to regulate crisis pregnancy centers through medical licensing requirements or consumer protection laws.  

Many of the bills were filed following an investigation by Reveal from The Center for Investigative Reporting that found that most centers operate in a kind of regulatory dead zone, free of significant state and federal oversight. Most states don’t require pregnancy centers that provide medical services to be licensed or inspected. They’re also not required to comply with the federal patient privacy law known as HIPAA. In many states, tanning salons, massage parlors and even pet stores face significantly stricter oversight. 

Kentucky state Rep. Sarah Stalker, a Democrat from Louisville, filed House Bill 489 after Reveal published a story about a Kentucky nurse who reported infection control issues at a pregnancy center where she volunteered. The center was using an expired disinfectant to sanitize equipment used in transvaginal ultrasounds. And that disinfectant had no efficacy against HPV, a widespread sexually transmitted infection responsible for most cervical cancers. In Kentucky, as in most of the country, pregnancy centers don’t have to be directly licensed and inspected by state authorities.

Pregnancy centers, which discourage women from obtaining abortion care, have proliferated in recent decades, with many aiming to expand their capacity now that Roe v. Wade has been overturned. An increasing number look and operate much like traditional OB-GYN providers, offering ultrasounds, tests for sexually transmitted infections and in some instances even prenatal care. More than 2,500 are open across the country, with more than 40 in Kentucky. 

After reading Reveal’s reporting on the Kentucky nurse whistleblower, Stalker said she grew concerned about the effect that unlicensed and unregulated centers could have on public health. In Kentucky, most counties do not have an OB-GYN, and the state’s maternal mortality rate is more than twice the national average. 

These centers’ existence or their overall mission are not up for debate with this proposal, Stalker said. “What I want people to have a conversation about is keeping people healthy and safe and their privacy protected. And that’s what this bill would do.”

The legislation would establish facility requirements, such as sanitation standards, staffing qualifications, maintenance of medical records and infection control protocols – regulations that are standard practice at most medical facilities in the state. Centers would be regulated by state health authorities. The bill also would create procedures for facility inspections, corrective action plans and a process for disciplinary action against centers.

The Kentucky Cabinet for Health and Family Services regulated pregnancy centers until 2018, when state legislators passed a law that erased the licensing requirements as part of a broader push to make it easier for hospitals to expand. Stalker said her bill aims to “close that loop.” Given the Republican supermajority in the Kentucky General Assembly, the bill did not advance through any committees during this year’s session. Stalker said she will file the proposal again next year. 

She modeled her legislation after a similar proposal in Indiana filed in January by state Sen. Shelli Yoder, a Democrat from Bloomington, which aims to create licensing standards for that state’s nearly 90 centers. Indiana is among 14 states that funnel taxpayer money to pregnancy centers through “alternatives to abortion” programs. But like in most states, “we have zero oversight and accountability” over centers, Yoder said.

“This is an industry seeking to be perceived as providing health care,” Yoder said. “We need to be talking about how we’re going to ensure that these facilities, these centers, are held to evidence-based standards of care for women.”

The lack of regulation stems from a 2018 U.S. Supreme Court decision overturning  the Reproductive FACT Act, a California law that required any clinic “providing family planning or pregnancy-related services” to let clients know that the state also offered free or low-cost reproductive services, including abortion, and to notify clients if it wasn’t licensed to provide medical care. Pregnancy centers argued that it infringed on their free speech rights.

The ruling created hurdles to new laws meant to protect clients from centers engaging in deceptive practices. But the overturning of Roe is reviving interest in legislation, with lawmakers attempting different approaches to regulate the pregnancy center industry.

In Texas, which funneled $100 million to pregnancy centers for 2022 and 2023, a Dallas representative filed a bill requiring that the state’s nearly 200 centers have at least one obstetrician or gynecologist on staff. More than 80% of centers in Texas don’t list a medical director or OB-GYN on their publicly available materials, Reveal’s analysis found.

Legislation in Arizona, Minnesota and New Jersey would require that pregnancy centers use licensed health care providers to provide ultrasound services. Four states – Minnesota, Massachusetts, Vermont, and Washington – are considering laws that would protect the data privacy of people visiting pregnancy centers. Because most centers aren’t subject to HIPAA, reproductive rights advocates worry that clients’ information could be shared and used to harass or, in anti-abortion states, to even prosecute patients who later seek abortions, their family members and their abortion providers. 

Some legislators are pursuing consumer protection laws. In recent years, a few states and cities have enacted such laws, which levy penalties against centers engaging in deceptive marketing practices.

In Colorado, Democratic lawmakers filed a package of bills to protect reproductive health care access. One bill would prohibit deceptive advertising by pregnancy centers and penalize licensed health care providers who provide the controversial treatment known as abortion pill reversal. The bill passed the state Senate last week.

“With the danger of (reproductive health) access being curtailed and rights in other states being taken away, it has just turned up the volume on how dangerous these practices are,” said state Rep. Karen McCormick, one of bill’s co-sponsors. “We should have addressed this a long time ago.”

This story was edited by Nina Martin and Kate Howard and copy edited by Nikki Frick. 

Laura C. Morel can be reached at lmorel@revealnews.org. Follow her on Twitter: @lauracmorel.

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Laura C. Morel (she/her) is a reporter for Reveal, covering reproductive health.

She previously covered immigration during the Trump administration. Before joining Reveal, Laura was a reporter at the Tampa Bay Times, where she covered criminal justice issues.

She was a 2022 finalist for the Livingston Award, which recognizes young journalists, along with Reveal data reporter Mohamed Al Elew for an investigation that exposed racial disparities within a federal lending program. She was also a Livingston finalist in 2017 as part of a team of reporters that investigated Walmart’s excessive use of police resources.