Calculated Cruelty
The anti-abortion movement is launching a national campaign to trick women into carrying doomed pregnancies to term
More than a year after Roe’s demise, Americans are still furious and Republicans are still losing at the polls—but the anti-abortion movement is full steam ahead. They’re thinking bigger than ever, cultural and political backlash be damned.
In addition to maintaining and expanding their state bans, activists are pushing for federal legislation, working to restrict birth control, funneling money to extremist crisis pregnancy centers, and making plans to open a national network of ‘maternity homes’. That’s to say nothing of their cultural campaigns to redefine birth control and preemptively blame doctors for the inevitable increases in maternal and infant death.
And while it’s hard to imagine anything crueler than the suffering we’ve already seen, the movement’s latest project may give all of their other efforts a run for their money.
The activists that decimated abortion rights have quietly rolled out a new initiative to pressure and force American women to carry doomed pregnancies to term.
It’s difficult to articulate the scale and cruelty of their vision, but I’ll try: This is a coalition of the most powerful anti-abortion groups in the country, coming together to change legislation, medical norms, patient care and more. They don’t just want to ban abortion in cases of fatal fetal abnormalities—but do away with prenatal testing altogether. It is massive, well-funded and terrifying. And they’ve launched it right under our noses.
Led by organizations like the Charlotte Lozier Institute (which is part of Susan B. Anthony Pro-Life America) and Heartbeat International (the largest network of crisis pregnancy centers in the world), this project goes beyond changing policy. Activists plan to embed themselves in hospitals, doctors’ offices and anywhere else pregnant women might be getting bad news.
And that’s what’s so galling about the effort: They’re pushing it under the guise of “prenatal diagnosis counseling” and perinatal hospice care—targeting and manipulating people in their most vulnerable life moments.
For the last few months, I’ve been investigating the different components of their strategy. Some are formalized and tangible, like PrenatalDiagnosis.org—which claims to be a resource for women whose pregnancies have been diagnosed with fatal or severe abnormalities. Launched by a coalition of anti-abortion groups like Heartbeat International, Her PLAN, and the Charlotte Lozier Institute, the site has been the campaign’s most public effort thus far. It features wildly false and dangerous misinformation.
Other efforts are less clearly-defined—like activists deliberately dropping key talking points about fatal abnormalities in media interviews, or floating trial balloons in their other, more public, work.
All of which is to say: there’s a lot. And so I’m sure that I’ll be adding to the below list in the coming months—but for now, here are the key elements of their strategy:
Disinformation on prenatal testing
As part of their effort to push and force women to carry doomed pregnancies to term, the anti-abortion movement has launched a disinformation campaign about prenatal testing—claiming that the tests aren’t accurate, and that the ‘industry’ itself is suspect.
Anti-abortion activists have criticized prenatal testing for a while now, mostly in their efforts to pass legislation prohibiting abortion based on a Down Syndrome diagnosis. But in the wake of Roe being overturned, conservatives have seriously ramped up their efforts. In part, it’s because so many states have bans with exceptions in cases of fatal fetal conditions—but it’s also because they know that women in states with bans will be seeking out the tests even more than in previous years.
They know these tests are going to be more important than ever to women, and that’s why they’re going after them.
The majority of content on the PrenatalDiagnosis website, for example, is false information about genetic testing. Again and again, the groups that run the site exaggerate problems with prenatal testing, and stress that “no genetic test or screen will always perform the way it should 100% of the time” or that “no test is 100% accurate.”
After women have gotten their initial test results—maybe from bloodwork—they try to dissuade women from doing further testing by highlighting the possible risk of miscarriage. The activists use language that suggests responsible parents would never put their baby in danger. Parents “who are concerned” with pregnancy loss, they write, “waive such testing.” Given that an amniocentesis has “[its] own risks to baby,” parents may “decline further testing.” Most egregiously, the site suggests that parents might end up “tragically terminate the life of their child based on an erroneous and incorrect” test result.
All of this aligns with messaging from the movement more broadly.
In addition to the misinformation and shaming directed at patients themselves, the anti-abortion movement is pushing legislators to go after the FDA approval and regulation of prenatal tests. Last year, nearly 100 Republican lawmakers sent a letter to the FDA asking about the labeling requirements and regulatory measures around the tests. Sen. Steve Daines said, “It is unacceptable that the FDA is not conducting proper oversight on these inconsistent prenatal tests that often pressure women into making a life-ending decision for their baby.”
Given the lawsuit challenging the FDA’s approval of mifepristone, I don’t need to tell you why a letter like that is concerning.
Legislators also wrote that the companies producing the tests “continue to see their profits grow.” That leads into the second part of the anti-abortion movement’s attacks on prenatal testing: Attacking the prenatal testing “industry.”
In the same way that conservatives have attacked abortion providers as a money-making “industry,” I’m starting to see signs that they’re planning the same kind of assault on the companies that produce prenatal tests. Here’s DiAnn Ecret—a nursing professor who works with The National Catholic Bioethics Center—in a podcast interview this past August about the supposed problems with prenatal testing:
“The prenatal screening is a huge business…. 8 billion in 2022 projected with another like 9 percent increase in profiting from prenatal screening and diagnosis.”
Sounds very familiar! Definitely something I’ll be keeping an eye on. (It’s also worth mentioning that Ecret works with Be Not Afraid, another organization behind the PrenatalDiagnosis campaign and website.)
On to the next element of their strategy.
Claiming women can’t make an informed decision after a diagnosis
This piece of their strategy is absolutely wild: Anti-abortion activists are laying the groundwork for a mandated waiting period for those diagnosed with fatal fetal abnormalities by claiming the trauma of the diagnosis impacts women’s decision-making. And, in keeping with being the absolute fucking worst, the groups behind this effort are using the language of treating “trauma” and concern over “informed consent” to make their argument.
In the same podcast I mentioned above, for example, check out what Ecret says about the trauma of receiving a devastating diagnosis:
“And with those traumatic experiences…stress responses that impede the growth and development of the baby, and also, more importantly, impedes that executive decision making capacity for families to make a decision if, if they're asked to, to abort the child that has this.”
We see similar language at PrenatalDiagnosis.org:
“Trauma has real impacts and some of them may be impacting you now. First, trauma makes remembering and organizing information and making decisions more difficult. If rushed, it may result in making a decision you regret later.”
There’s a few reasons that they’re doing this: the first is to lay the “expert” groundwork to push for a legal waiting period. And specifically, doing so in a way that makes it seem as if they give a shit about women. That’s the exact strategy that the groups trying to ban abortion medication have used. And the language of “informed consent”—which is repeated in their podcasts, policy papers and sites—is the same rhetoric the movement used to pass laws mandating that doctors tell women false information about abortion, and to enact waiting periods.
The other reason to claim that the (very real!) trauma that comes from a tragic diagnosis impedes decision-making is to urge individual women to wait on having an abortion. It’s a tactic straight out of crisis pregnancy centers: the longer they can convince women to wait, the more difficult it’s going to be for them to get care.
Manipulating medical & legal language
If you’re a regular reader, you know that manipulating language is one of the anti-abortion movement’s primary tactics—from doing away with ‘ban’ to redefining abortion. In this case, they’re working to change medical terms in order to hide the seriousness of severe and fatal fetal diagnosis. The best example of this comes from the anti-abortion organization, the American Association of Pro-Life Obstetricians and Gynecologists.
Working with the Charlotte Lozier Institute, AAPLOG created a glossary of “life-affirming” language changes that they’re pushing onto medical professionals and into legislation. The groups recommend saying that a condition is “potentially life-limiting” as opposed to fatal, and “pre-viable” instead of “non-viable.” The idea is to make women believe that there’s a chance their fetus might survive, even if that’s never going to happen.
These invented ‘medical’ terms have already made their way into legislation. In North Carolina, for example, the state’s recently passed ban outlines an exception for “life-limiting anomalies.” If a patient qualifies for that exception, they must fill out a consent form from the state that also uses the term—along with other language crafted specifically to dissuade women from ending their doomed pregnancies.
Patients must affirm, for example, that they’ve been counseled on “the risks that the fetus could die before birth and the fact that some infants with life-limiting disorders are born alive and could have an unknown length of life.” Telling women that the pregnancy could end on its own is a common tactic in crisis pregnancy centers; the hope is that women will forgo an abortion, believing the pregnancy will end on its own without intervention. And claiming that the baby could live—that you just never know—is another way to give patients false hope.
The goal with all of these terms and language changes is to trick people into carrying a doomed pregnancy to term, no matter what the risks. Which brings us to the next tactic…
Lying to patients about the risks of continuing their pregnancy
We know that anti-abortion groups aren’t concerned with women’s lives. That’s why they’re trying to downplay post-Roe maternal mortality numbers, and why they fight against health (and even life!) exceptions in their abortion bans. Their priority is to prevent abortion, no matter what the risk to a patient’s life. (In my New York Times column earlier this month, for example, I wrote about AAPLOG’s recommendation that doctors allow women with deadly pregnancy complications like placental abruptions to labor for 24 hours, giving them with blood transfusions and intensive care instead of an abortions so that they deliver “an intact fetal body.”)
Now, any OBGYN will tell you that pregnancy in itself is a health risk—not being pregnant is always safer than being pregnant. But the health risks associated with pregnancy can be even greater when you’re talking about a complicated pregnancy, or a fetus with a severe or fatal condition. The longer you remain pregnant, the more dangerous it can become. The anti-abortion movement doesn’t want women to know that.
PrenatalDiagnosis pushes women over and again to give birth to babies that will not live, downplaying the risk to their health and lives. In fact, the site contains just three measly paragraphs dedicated to the physical risks of carrying a doomed pregnancy to term—all three of which suggest there are no such risks.
Dr. John Bruchalski, one of the three medical professionals listed as the site’s leadership, writes, “In the majority of cases a pregnancy complicated by a prenatal diagnosis poses no greater maternal medical risk than a pregnancy which is not complicated by prenatal diagnosis.” Bruchalski also writes that “delayed delivery maximizes time the family spends with the baby.”
It will not shock you to find out that Bruchalski is an anti-choice doctor who frequently testifies in favor of abortion bans and restrictions—and who doesn’t much give a shit whether women suffer. And I mean that literally.
In a piece for Newsweek about fatal fetal diagnoses, Bruchalski argues that abortion “simply trades the mother's physical suffering in continuing the pregnancy for psychological suffering.” And in a interview last year, Bruchalski said that providing abortions in cases of doomed pregnancies would be “robbing our patients of an opportunity for courage, or underestimating their capacity to face suffering.” Truly chilling.
These activists know that their policies hurt women and put their lives in danger. If you have any doubt of that, I’ll just leave you with the disclaimer at the bottom of the PrenatalDiagnosis website:
“PrenatalDiagnosis.org accepts no liability for the consequences of any actions taken on the basis of the information provided. This website is not intended to be direct medical, legal, or ethical advice for your specific situation. Please contact your physician, lawyer, or pastor for additional help.”
This, after page after page of giving medical advice.
Lying to patients about the risks of having an abortion
Conservatives have been lying about the supposed risks of abortion for decades (even though ending a pregnancy is safer than getting a wisdom tooth removed). Remember, they’re so desperate to convince people that abortion is dangerous that they’re fabricating abortion complication data:
When it comes to ‘counseling’ women about fatal fetal abnormalities, anti-choice groups are focusing more on the emotional aspect of abortion more than anything else. The groups claim that there’s an emotional “benefit” to carrying a doomed pregnancy to term.
This isn’t just a talking point in policy papers and testimony; it’s a myth that’s made its way down to individual doctors counseling patients. This summer, I interviewed a Texas woman who was denied an abortion despite a horrific and fatal diagnosis. Her OBGYN, who was anti-abortion, advised Terry to carry the pregnancy to term—telling her it would be emotionally better to have a moment with the baby. (Terry told me, “As much as I wish I had the chance to hold my baby, I don’t think anyone would want to see something that has no head.”)
Of course, the movement is still pushing lies about the physical risks of abortion, as well. And because fetal abnormalities are often diagnosed later in pregnancy, activists doing prenatal diagnosis work focus on scare tactics around abortions later in pregnancy.
Training and embedding prenatal diagnosis ‘counselors’
The anti-abortion movement has a built-in network of activists via crisis pregnancy centers. They’re everywhere. And so as part of their campaign to convince women to carry doomed pregnancies to term, the movement is training volunteers with the goal of placing them anywhere a woman might have recently gotten bad news.
They are selling digital workshops with names like “Informed Consent Following a Prenatal Diagnosis,” and training crisis pregnancy centers workers at their major conferences. At this year’s annual conference for Heartbeat International, for example, one of the organization’s board members held an informational session and training on “informed consent” after a diagnosis.
Gary Thome told the audience of volunteers about how women “engage in the fight, flight, or freeze response” after a diagnosis:
“Trauma also means a loss of executive function in the brain, meaning people undergoing trauma physically cannot think logically, form memories correctly, or do any future-planning.”
And in keeping with all of the other anti-abortion tactics I’ve outlined, Thome advised the volunteers to tell women about the “high rate” of false positives in prenatal testing and to push back on doctors using “lethal language” about the diagnosis.
In addition to Heartbeat International, Be Not Afraid is also running trainings for “parent care coordinators” throughout the country.
How will they get to women? That’s easy: just force hospitals to recommend them.
In Indiana’s abortion ban, the ‘exception’ for cases of fatal fetal abnormality requires doctors to tell patients about perinatal hospice services—which would be reasonable if the services were non-ideological and offered as part of a full spectrum of care. But check out the brochure that the law mandates women are given.
Not only does the information forced on patients direct them to anti-abortion groups (including the Charlotte Lozier Institute), it also tells women that having an abortion might kill them:
“If an abortion is performed this late in the pregnancy, it significantly increases the risk of death or complication. Mothers may also risk complications with future pregnancies, including premature birth and low birthweight after an abortion.”
But don’t worry, they say that parents have found giving birth to a dead baby to be “a beautiful, profoundly meaningful, and healing journey.”
This isn’t just an issue in anti-choice states: If Republicans are successful in passing federal anti-abortion legislation, part of their plan—in addition to launching a government website that would collect data on pregnant women—is to create a portal of ‘resources’, including those on prenatal diagnosis counseling.
Using funding for crisis pregnancy centers to make it all happen
For the anti-abortion movement, finding the money to fund all of this is easy. To start, the national organizations like Susan B. Anthony Pro-Life America have dollars to spare. But with millions in state funding going to crisis pregnancy centers, anti-choice activists have another, new, way of subsidizing their ‘prenatal’ cruelty.
After all, we know that the total lack of regulation around funding for anti-abortion centers allows them to basically funnel it where-ever and however they want. (Remember the North Carolina state Senator who figured out that $20 million was being sent to people’s private residences and empty storefronts??) State funding for crisis pregnancy centers will often go through an umbrella network first, and then that organization will decide where the millions of dollars go. They really are being given free reign.
Anti-abortion groups are also deliberately positioning themselves to best take advantage of the post-Roe horror: Given abortion bans, the spread of misinformation, and other hurdles to access, the infant mortality rates in anti-choice states will increase. That increase will give Republicans the opportunity (and excuse) they need to earmark funding for groups that claim to be experts and counselors in prenatal counseling and perinatal palliative care. Lo and behold, anti-abortion activists are at the ready.
There’s a reason this long-planned project isn’t being widely publicized. With any other large-scale effort, the organizations behind all of this would be putting out press releases or giving interviews. That’s not happening here. Instead, most of the work they’re doing is behind-the-scenes. Which makes sense: Reminding Americans that you want to force women to carry dead and dying fetuses isn’t exactly good PR.
But these groups have had years of practice infiltrating communities and culture via crisis pregnancy centers, and they are well-prepared to meet this next, very dark, moment.
The truth is that conservatives want to fund the worst kind of people and the worst kind of lies. They want to embed them in our communities, and give people who do not care about us the opportunity to manipulate women in their most desperate and vulnerable moments. Worst of all, they think we won’t notice.
I’m hoping that this piece ensures that doesn’t happen.
The infantilization of women is stunning--along with everything else you have written. Thank you for keeping everyone on top of important news about choice.
" I wrote about AAPLOG’s recommendation that doctors allow women with deadly pregnancy complications like placental abruptions to labor for 24 hours, giving them with blood transfusions and intensive care instead of an abortions so that they deliver “an intact fetal body.”)"
This quotation makes zero sense. I have been a labor and delivery nurse for 21 years. We see pregnant patients who are 20 weeks and above. The placental abruption cases I have been involved in do not require an abortion. This is not part of the care this pregnant patient will receive. The abruption is recognized because of a big gush of an ABSURD amount of blood, or the fetal heart rate drops and stays down and will not come back up to normal or the patient (even laboring with an epidural) will scream out in pain because when the placenta pulls away from the uterus it HURTS! The patient will be rushed to the operating room, a cesarean section will be performed and the NICU team will be in the operating room to receive the baby. Once the baby is delivered the patient will receive uterotonics (medications to stop the bleeding), blood transfusions, surgical maneuvers to try to clamp her uterus down (the MD's try REALLY hard to save a patients uterus in these cases) and/or at the very last resort a hysterectomy to save the mother's life because the bleeding will NOT stop.
The scenario given by the AAPLOG is not even a real scenario. Abortion is NOT the intervention for placental abruption. A dead woman CAN NOT labor. We are delivering an intact fetal body via cesarean section. This baby has a good chance of survival if the patient is in a hospital laboring or if they recognize their bleeding is profuse and abnormal and get to the hospital FAST. We can get them into the operating room and the baby out in less than 10 minutes!
The problem that the AAPLOG should be focused on is the maternity deserts that they have created with their abortion bans. If a placental abruption happens to a pregnant person living in these areas the mother and baby will definitely die. Fifty miles, ninety miles to the nearest hospital with a labor and delivery unit is TOO FAR!
I know I just went on FOREVER and you have probably stopped reading but if you haven't I guess my point is that people must be educated by actual medical professionals. The AAPLOG is literally lying about this pregnancy complication. This along with all the other misinformation they are peddling harms patients and their family's.