The phones at Problem Pregnancy rarely fall silent for more than a few minutes at a time.
The director of Providence's only crisis pregnancy center, David O'Connell, sat in the facility's lending library while he discussed its work, surrounded by pamphlets with titles such as "The Decision of Life" and "Contraception and Abortion: The Deadly Connection." If no one had answered the phone by its third ring, O'Connell jumped up, briefly excusing himself to take the call.
Operating inside the Mother of Life building on Atwells Avenue, Problem Pregnancy is an independent Catholic organization that seeks to provide alternatives to abortion for women with unplanned pregnancies.
"Last year we saw 572 women by appointment," O'Connell said. "So there's a great need for what we do."
Crisis pregnancy centers, or CPCs, now outnumber abortion clinics in the United States, according to an article published in Time magazine last month. The centers support women during pregnancy, often providing pre- and post-abortion counseling. But critics say they use emotional pressure and misinformation to steer women away from abortion.
Care Net, one of country's largest CPC organizations, is a Christian group with a facility in Cranston. In a May 2006 report, Care Net's headquarters estimated there were a total of 2,300 crisis pregnancy centers nationwide, and the Time article reported that Florida, Texas, California and Ohio had well over 100 centers each.
"Some states have multiple Care Net centers," said Janet Evanco, director of CareNet Rhode Island in Cranston. "We just feel we have a special mission as the only one in Rhode Island."
Founded in the 1980s, Problem Pregnancy and CareNet are the two crisis pregnancy centers closest to Brown's campus, though there are additional centers in Westerly and Middletown. There are currently more CPCs than abortion providers in the state, as there are only two abortion clinics in Rhode Island.
Representatives from both the state's CPCs and abortion providers insist they have little direct interaction. But before Women's Surgical Services closed its doors in October 2004, the abortion clinic stood across the street from Problem Pregnancy on Atwells Avenue. Women's Surgical's former location partly influenced Problem Pregnancy's 2004 relocation to Atwells, said the center's counselor, Marlo Mooney. Though occasionally aided by community volunteers, Mooney and O'Connell are the center's only full-time employees.
Both CareNet and Problem Pregnancy provide female clients with a variety of free services, beginning with a rapid pregnancy test. If the woman is pregnant and seems undecided about what to do, the centers provide her with "pre-abortion option consultation" that includes "full information regarding the abortion procedure and its risks, the adoption option and the parenting option," Evanco said.
Though the centers offer services to women regardless of their religious beliefs, spirituality is often brought up during counseling sessions.
"We may ask them, 'Do you have a parish that you belong to? Do you believe in God? How do you think God feels about your condition right now?' " O'Connell said, adding that Problem Pregnancy routinely connects women who express an interest in religion to local churches.
If a woman remains unsure of what to do after counseling, the centers will offer to give her an ultrasound.
Because Problem Pregnancy's sole counselor, Mooney, holds a bachelor's degree in social work and not nursing, she cannot perform the procedure. A certified nurse comes to the center twice a month to administer ultrasounds to women O'Connell described as "most abortion vulnerable."
CareNet's counselors, who are trained using "Equipped to Serve," a counseling manual produced by a former Baltimore CPC director, are also uncertified to perform ultrasounds. The center's brand new ultrasound machine is still in its wrapping, resting in the middle of the center's former kitchen.
Purchased with a grant from faith-based nonprofit Focus on the Family, the machine has prompted what Evanco called CareNet's "medical conversion process." Once the process is complete, the center will be able to offer clients first trimester ultrasounds during all three of its operating days each week. Currently, CareNet patients who accept the counselors' ultrasound offer are sent to a CPC in Fall River, Mass.
Both Evanco and Mooney deny using emotional pressure when counseling their clients.
"We do not use any kind of graphic pictures," Evanco said, adding that CareNet employees are not judgmental or coercive during counseling sessions.
Mooney said she does not regularly use visual aids when speaking to clients, but the center's waiting room contains a pamphlet with graphic pictures of aborted fetuses. Mooney said the pictures were partly there for community members researching abortion at the center.
"90 percent of the time I don't use that in counseling," she said, adding that she only shows the pamphlet to clients who request to see it.
CareNet gives its clients pamphlets warning them about the dangers of abortion, such as one titled, "Making an Informed Decision About Pregnancy," which lists hemorrhage, infection leading to infertility, breast cancer and, occasionally, death as potential risks.
"We will not give out any information that has not been verified or researched as being truthful. That's number one - to speak the truth," Evanco said.
Some of the center's data conflicts with more recent studies. In 2003, the National Cancer Institute - a part of the National Institutes of Health - found there was no link between breast cancer and abortion. The Guttmacher Institute, a nonprofit affiliated with Planned Parenthood, found in 1999 that fewer than 0.3 percent of abortion patients require hospitalization after the procedure. According to a 2006 study cited by the institute, the fatality risk of childbirth is 12 times as high as the risk associated with an abortion.
In addition to abortion's physical dangers, the centers also advise women of the emotional trauma they may experience after an abortion. Evanco said she regularly speaks with grief-stricken women who take part in CareNet's 10-week post-abortion recovery program.
Problem Pregnancy materials that describe post-abortion stress, such as "Surgical Abortion: Your Risks," cite teenage abortion patients as 10 times more likely to commit suicide in the six months after their procedure than other teenage girls. The pamphlet frequently references the research of David Reardon, founder of the pro-life Elliot Institute, who holds a Ph.D. from Pacific Western University, an unaccredited, online college based in San Diego.
Both centers also help newly pregnant women find housing and financial assistance through government programs like Medicaid. Problem Pregnancy is affiliated with the Little Flower Home in Tiverton, where women can live while carrying their pregnancy to term.
Some long-term clients also receive baby supplies. CareNet's New Beginnings program awards women who attend weekly counseling sessions "baby bucks" that can be used in the center's "shop," filled with clothes, blankets and other accessories donated by Wal-Mart and Kohl's department store.
As pro-abstinence organizations, the centers do not offer clients contraception, though Evanco said CareNet refers women seeking birth control to a physician. CareNet receives federal funding for its "sexual integrity abstinence program," while Problem Pregnancy benefits from state grants. Yet both centers largely rely on charitable donations.
Some of the funds are reserved for advertisements, like the ones O'Connell said Problem Pregnancy places near Providence's high schools, colleges and bars. The four CareNet billboards in Rhode Island read "Pregnant and Scared?" and list an 800 number for women to call, according to Evanco.
Both Evanco and Mooney said they always tell women looking for abortions that the centers do not provide them.
"We're up front about that. We're not trying to trick somebody," Mooney said.
Still, it seems some women may not know what to expect when visiting a CPC.
Linda, a counselor at Women's Medical Center in Cranston - one of the state's two abortion providers - declined to give her last name but said her patients have described being "guilted" and "terrified" at local crisis pregnancy centers.
Lori Larusso, another counselor at Women's Medical Center, said one patient told her a CPC in Massachusetts had incorrectly informed her she could not have an abortion until she was 12 weeks pregnant.
"These centers try to make it very emotional for the women. ... They talk to them about being a 'mommy,'" Larusso said.
Linda disputed CPCs' claims that abortions are unsafe.
"I wouldn't be here if I didn't think it was safe," she said. "I'd send my daughter here."
Counselors at both Women's Medical Center and Planned Parenthood said they send women away on the day of their procedure if they sense any hesitation, and both clinics inform patients of non-abortion options.
"Anyone who's telling us she's undecided, we say, 'Look, go home,' " said Harriet Singer, a counselor at Planned Parenthood. "Perhaps if you're sure enough tomorrow, you can come back. ... But not today."
J. Cherry, health educator at University Health Services, said she would never send a student to a CPC because some of them "give out misinformation."
But some students agree with the centers' work. Joanna Joly '07, president of Brown Students for Life, brought O'Connell to campus last semester to speak about student volunteer opportunities at Problem Pregnancy.
"I think that the pregnancy centers in Providence are an extremely important part of the pro-life movement here," said Joly, who is planning a pro-life discussion panel for April.
Other students disagree with the CPCs' practices.
"It's really terrible that they're federally funded," said Lily Shield '09, a member of Brown's Students for Choice. "That seems to violate the boundary of church and state." Shield also described the CPCs' practices as "guilt-tripping."
Standing in one of the center's counseling rooms, Evanco shook her head when considering criticisms of the center. She'd just spent an hour describing how CareNet builds relationships with its clients and provides them with a second family when they need it most, sometimes going so far as to ride with women to the hospital after they go into labor. But just in case she hadn't made herself clear or had misrepresented the center to college women who she believes might need it most, Evanco repeated the center's mission.
"We are pro-woman," she said. "We want them to have all the facts about abortion, the procedure and its risks. And just to be there for them."
