They look like any ordinary medical office — with employees wearing scrubs and offering free sonograms and pregnancy tests — but they are not. They are called “crisis pregnancy centers,” and although they promote themselves as places that provide scientific medical information about options for an unwanted pregnancy, in practice, they are anti-abortion centers that use deception, manipulation, and incomplete or false information, often from a religious perspective, to convince pregnant people to continue with a pregnancy they do not want.

In Puerto Rico, there are three of these pseudo-clinics: two of the Hope Women’s Clinic in Río Piedras and Bayamón, and Centro Raquel in Carolina. All are located near or next to one of the four clinics offering abortion services in Puerto Rico, an essential health procedure that only a licensed physician can perform.

Unlike legitimate clinics, which are highly regulated by the Department of Health (DS, in Spanish), these “crisis pregnancy centers” operate freely, without regulation by the DS, hence without medical permits, confirmed the Unidad Investigativa de Género (Gender Investigative Unit), an alliance between the media outlet Todas and the Centro de Periodismo Investigativo (CPI). Two of these establishments claim on their websites to be “non-judgmental” places with “advisors” who can help, but none were able to provide data on their personnel to support that claim. Some of these places receive support from private and governmental entities, which send staff to their facilities to offer talks and guidance.

These crisis pregnancy centers are models imported from the United States. Robert Pearson, a Catholic, founded the first one in Hawaii in 1967. Since then, they have proliferated with the backing of religious organizations, eventually reaching Puerto Rico. As they have grown, The American College of Obstetricians and Gynecologists (ACOG) warns that the objective of these centers is “to dissuade people from accessing certain types of reproductive health, including abortion and contraceptive options.”

The Cost of Arriving at the Wrong Place

It is very easy to mistakenly end up at one of these establishments.

It happened to “María,” who asked to be identified by a pseudonym due to the stigma that persists against those who exercise their right to have an abortion. But she is not the only one.

From the moment she found out she was pregnant, María wanted to terminate her pregnancy with the “abortion pill,” the common name for mifepristone and misoprostol, which must be taken within 24 to 48 hours to induce an abortion during the first trimester without the need for a doctor’s intervention. She never imagined that she would endure a nightmare and end up in a place where her wish would be pushed back, where she would be made to feel guilty for her decision, and where they would try to convince her to carry a pregnancy she never wanted.

Because she had an unpleasant experience with her first abortion, María searched online for a new place that offered the service and provided the pills she was looking for. That’s how she found Hope Women’s Clinic in Bayamón, a place that offered “free and confidential pregnancy services,” free pregnancy tests and sonograms, and guidance on three options: abortion, parenting, and adoption. A “safe and non-judgmental place,” the website said. The button to make an appointment was so accessible that, although María read that this center did not perform abortions, she decided to go for information.

Pseudo-clinics like Hope Women’s Clinic use search engine optimization strategies to appear among the top results on browsers like Google. For example, a search for the phrase “abortion pill PR,” conducted from Puerto Rico, often shows the facility’s website among the top results or as sponsored content, even though it is not a clinic and cannot provide abortion pills.

The two Hope Women’s Clinic centers and Centro Raquel, the third anti-abortion center in the archipelago, appear on Google Maps. Hope Women’s Clinic, known as CREE Women’s Center, until late April 2024, has deleted negative reviews from people trying to warn that it is a place working against the right to abortion and not a legitimate clinic regulated by the Department of Health..

When María arrived at the parking lot, she saw the bright sign that said Hope Women’s Clinic. She nervously entered what she believed to be a medical office. There was a reception desk, several chairs, relaxing music, some papers, snacks, and water.

All the employees were dressed in gray scrubs, as if they were nurses or medical staff, including the receptionist, who greeted her kindly and handed her some papers to sign. María sat in one of the chairs next to other patients. She quickly glanced over the papers, one of which stated that no one in the office was a nurse. It struck her as odd, but she signed. Another mentioned the HIPAA law, which protects patient information, and she signed that, too. Another talked about sharing information with third parties. She signed. She just wanted to get information about abortion and end a situation that made her anxious, with morning sickness and irritability because she knew she was racing against time.

She recalls walking down a hallway leading to an office with a sofa and an armchair under dim, almost nostalgic lighting. It looked like a psychologist’s office. A woman, whose name she did not remember, sat before her and began questioning her.

— What’s your relationship status? What’s your housing situation? Do you have the financial resources to have a baby?

— I don’t want to proceed with this pregnancy — María interrupted her. — I just want information on getting the abortion pill.

— If you think that’s an easier or less painful way, you’re wrong. Do you know how these pills work?” the person, posing as a nurse, asked her.

— I’m not sure — María replied, clutching her hands tightly on her legs. — I know the goal but don’t know the ‘in-betweens.’ That’s why I’m here, to get information.

— The pill cuts off the baby’s food, — said the woman, using the word “baby” instead of an embryo. — You’ll be alone. You’ll have pains as if you were giving birth. You’ll have contractions. You won’t be able to work for two weeks. If you think it’s simple, it’s not. You’ll have to see what you’re aborting yourself. But my dear, how old are you? Do you have a partner?

— I’m 29. Yes, I have a partner — María responded.

— But you’re at the perfect age to be a mother! You know that after a certain age, the chances decrease. You have a partner, a job, and we can help you with everything, — said the pseudo-nurse, grabbing surgical clamps. — If you take the pill and the baby doesn’t come out completely, they’ll have to scrape you, — she added, scraping the clamps against a surface, making them sound loud, “Prrrrra!” According to the World Health Organization, the woman omitted that this method is up to 98% effective when used correctly in the first nine weeks.

The sound echoed in María’s ears, and she imagined that metal tool inside her womb. Her eyes welled up. She didn’t know what to say.

— Do you believe in God? What are your religious beliefs? — the woman asked.

— I’m not religious, but I am very spiritual — María responded.

— I don’t think you’re here by chance. I think you came here with a purpose, and we can help you. We can give you birthing classes, baby clothes, and everything you need in that first year — food and diapers. You won’t lack anything. Look, we’ll do a pregnancy test, and then you can come back on Monday when the doctor is here, and she’ll give you a free sonogram. Even if you decide to abort, the sonogram is important to make sure everything is fine.

María agreed. She took a urine pregnancy test, which the staff told her had “laboratory quality.” It came back positive. She talked a bit more with the woman, who continued explaining the services offered at Hope Women’s Clinic, and she scheduled an appointment for the sonogram the following Monday.

— Do you know the repercussions of abortion? Emotionally, you’ll feel sad. Many people can’t recover after having an abortion. It also has physiological risks. If this is your second abortion, you could become sterile. Here, take everything you need, — the woman in the nurse’s uniform said, handing her a brown paper bag.

People who have abortions experience the process differently, depending on their personal, social, and cultural circumstances, as documented by the American Psychological Association and the American Psychiatric Association.

María left feeling dazed. She had never heard what they were telling her there, and during her first abortion, she had felt some pain because it was done with instruments, but she had never felt emotionally distressed. She walked quickly to her car, sat in the driver’s seat, and opened the bag. Inside was a newborn diaper, some prenatal vitamins, and a card with a QR code. There was nothing about abortion. María burst into tears. She threw the pills and the diaper out the window. She felt overwhelmed. She began to question the decision she hadn’t questioned until that moment. She grabbed her phone and scanned the QR code, only to find information about the prenatal vitamins she had just thrown away. She cried desperately.

“They made me doubt my choice and made me feel guilty. They planted that seed of doubt that I didn’t have,” María told the Unidad Investigativa de Género weeks later in a café, holding back tears, with a lemonade on the table that she didn’t touch throughout the conversation.

María returned once more to the pseudo-clinic Hope because they told her that the sonogram was necessary for whatever decision she was going to make, and they could do it for free with a “doctor.” They had texted her a couple of times to ask if she was coming to the appointment, if she wanted a new date, and if she had decided.

To perform the sonogram, they took her to another office that had an ultrasound machine, an examination table, a computer, and some gift boxes with baby clothes and diapers. The alleged doctor introduced herself, but María was too nervous to remember her name. She lay down with her belly exposed, feeling the cold, sticky gel on her skin and the small thump of the transducer.

The “doctor” looked at the screen, printed a small piece of paper with the ultrasound image, and picked up one of the tiny dolls arranged on a table.

— You’re nine weeks along. You’ll have your baby on this date. Your baby looks like this — the alleged doctor said, placing the tiny doll in María’s hands.

María looked at the doll and didn’t know what to do with it. Faced with María’s insecurity, the woman charged her with a glare. She began her speech again: That they were there to help her, that they would give her everything she needed, that they had vouchers for baby items, and she repeated all the alleged side effects of abortion.

María thanked her for the service, and as she left Hope, she came across an anti-abortion propaganda table just steps from the building. Then she realized it was an anti-abortion center. “It’s too much of a coincidence that one thing is next to the other. These people are definitely trying to convince you,” she said while recalling that moment.

During a visit by the Unidad Investigativa de Género to the Hope Women’s Clinic in Río Piedras, an employee who identified herself as Frances and was dressed in scrubs refused to say what type of medical professionals worked at the center or to whom they were accountable because “we’re not authorized to answer questions from journalists.” However, she confirmed that they had an ultrasound machine operated by “a professional” despite not being a center regulated by the Department of Health.

After María had the sonogram at the Bayamón pseudo-clinic, the fear she felt led her to schedule an appointment with a gynecologist who, although not performing abortions, reassured her about the procedure. She told María that it was false that she could become sterile and that she didn’t understand why she felt so guilty, as it was a procedure that many people undergo. One in four women in the United States will have an abortion during their lifetime, according to an analysis by the Guttmacher Institute. The doctor also recommended a place where she could safely terminate her pregnancy if that were her decision.

That’s how María ended up at Darlington Medical Associates in Río Piedras, one of the four clinics that perform abortions in Puerto Rico, all regulated by the Department of Health.

Crisis Pregnancy Centers in Puerto Rico: Largely Unknown, Yet Highly Impactful

Hope Women’s Clinic has two establishments. There’s the one María visited in Bayamón, which is the first “crisis pregnancy center” in Puerto Rico and opened in 2016, just steps from the Family Planning Center, a legitimate abortion clinic. The second one opened this year in Río Piedras, near Darlington Medical Associates. In Carolina, there is Centro Raquel, near the Women’s Medical Pavilion, which is another regulated clinic for abortion services.

Hope Women’s Clinics are owned by Joseph and Daisy Pardo and their nonprofit organization, Love the Nations. This entity also runs other initiatives, such as “Defensores en las Aceras” (Sidewalk Defenders), a group dedicated to intimidating and harassing people who come to abortion clinics to dissuade them. They also hold protests and “pro-life” events. They are supported by Great Commission Partnerships, an entity that identifies as Christian and sponsors anti-abortion missions worldwide.

In February 2023, Love the Nations reached a collaborative agreement with the Municipality of San Sebastián to use the town’s Fine Arts Center for free to offer “an educational workshop on abortion and related matters,” called “Toda la Vida/CREE Women’s Care.” The contract is signed by San Sebastián’s deputy mayor — and also a candidate for the mayor’s office —Camilo Ortiz Maldonado, representing Mayor Javier Jiménez, who is currently running for governor for the anti-abortion party Proyecto Dignidad (Dignity Project party).

Pardo donated $100 to Rep. Lissie Burgos Muñiz, who is running for re-election for the same position under the Proyecto Dignidad party. The lawmaker gave a recognition paid for with legislative funds to the establishment in San Sebastián, as well as to Centro Raquel and other anti-abortion entities. In the Senate, President José Luis Dalmau Santiago, of the Popular Democratic Party (PPD), and Poyecto Dignidad Sen. Joanne Rodríguez Veve, backed the recognition.

Despite contacting the Senate and the press spokesperson for Dalmau Santiago several times, no information was provided regarding whether the legislative body had offered funds to any of these centers. The Department of the Family did not respond to several requests for information about whether the agency had provided state or federal funds to any of these entities through the Temporary Assistance for Needy Families (TANF) program, as has happened in some U.S. states, according to investigative journalism outlets.

Joseph Pardo is the president and chairman of the board of directors of Hope Women’s Clinic, he confirmed in a phone call. However, when questioned about complaints of false or incorrect information provided by the centers, he limited his response to saying in English: “I prefer not to comment on that. What is your name?” He later sent a text message with the address to the Hope website, saying that information about the entity could be found there. Still, he refused to answer whether he was in Puerto Rico (his phone number is from Tampa, and Love the Nations is based there), what types of funds they receive, who works at the center, and the source of the information they provide. He also declined to schedule an interview.

The website lovethenations.com automatically redirects to pregnancypr.com, where a section for donations from beneficiaries of Acts 20/22, now Act 60 on tax incentives, is highlighted. In 2022, Hope Women’s Clinic received $110,958 from foreign investors established in Puerto Rico, according to data obtained by the CPI from the Department of Economic Development and Commerce (DDEC). The website also features testimonial videos linked to the YouTube channel “Toda la Vida PR,” which includes videos, such as one comparing sexual consent and pregnancy to eating carbohydrates and not gaining weight.

The page embarazopr.com, by Love the Nations, redirects to hopewomansclinicpr.com, where they offer counseling on parenting, adoption, and abortion and claim: “We are a safe, non-judgmental place where you can get the answers and support you need.”

Operating Without Health Department Permits

None of these pseudo-clinics are registered with the Department of Health, even though they claim to offer medical services. They also offer sonograms, which are performed using ultrasound machines. According to Act 37 of 2007, “any person or institution not authorized to practice medicine in the Commonwealth of Puerto Rico can acquire or administer an ultrasound machine under penalty of a fine of no less than $5,000 and immediate confiscation of the equipment.”

However, the Department of Health denies knowing these centers’ existence. “Our agency has no information regarding this type of facility known as Crisis Pregnancy Centers,” Health Secretary Carlos Mellado wrote in a document responding to an information request from Sen. Ana Irma Rivera Lassén. The legislator has been investigating how these centers operate for weeks, as she believes they may be obstructing access to abortion, which is legal in Puerto Rico following the Pueblo v. Duarte decision.

Mellado wrote that the Health Institutions Section of the Public Health Regulation Secretariat at the Department of Health is unaware if the so-called crisis pregnancy centers in Puerto Rico receive public funds. He stated that they have no statistics on the matter and do not conduct any type of regulation or supervision of these centers. They don’t intervene to ensure that the centers comply with federal medical information privacy laws. He assured that they do not know if these anti-abortion centers have authorized and qualified medical personnel, and they have not investigated whether the information they provide is based on evidence and medical practices, as “we have no information regarding this type of facility.”

However, the director of Centro Raquel, Lilibeth Febres, told the Unidad Investigativa de Género that the Department of Health sends a representative from the agency to provide prenatal, breastfeeding, and parenting guidance. Meanwhile, the Department of the Family collaborates with them on adoption topics, and the Agricultural Extension Service sends a representative to provide nutrition counseling.

The Department of Health was contacted multiple times to request an interview, and even sent the questions, but the agency did not respond.

“It’s concerning. You have a center that people think they’re arriving at for medical services or a clinic that deals with sexual and reproductive rights. It turns out that’s not the case,” warned Rivera Lassén in an interview with the Unidad Investigativa de Género.

The centers could also be violating the privacy rights of pregnant people, interrupting access to medical services and accurate information about their reproductive rights, Rivera Lassén said. “In addition, they are alarmist and not only fail to tell the truth but aim to make people carry unwanted pregnancies; they force motherhood.”.

College of Physicians: “This Must Be Investigated”

The president of the Puerto Rico College of Physicians and Surgeons, Carlos Díaz Vélez, said his organization has not addressed the issue of crisis pregnancy centers in any of its meetings. He acknowledged that abortion “is a right” and that if entities are posing as clinics to convince people to give birth, “that is against the law and the Department of Health’s regulations.”

“We completely disagree. This must be investigated, and the appropriate complaints must be filed,” said Díaz Vélez, who assured that he would raise the issue with the Secretary of Health due to all the problems it implies for public health.

The physician explained that these centers might be advertising themselves deceptively, violating patient rights and HIPAA laws, and disrespecting the decisions of pregnant people, something that all licensed medical personnel are obligated to respect. He emphasized that it is one thing to explain the risks of a medical procedure like abortion and obtain informed consent and another to “try to manipulate people into changing [their minds]. That should not be their role.”

Someone familiar with the situation and who’s gathering various testimonies to file a formal complaint with the authorities is Dr. Yarí Vale Moreno, a gynecologist at Darlington Medical Associates. “I have had patients who end up there [at Hope] without wanting to” because of how close it is to her clinic, she said.

One of the problems with anti-abortion centers is that “they obstruct a patient from reaching a legitimate clinic,” and time is essential in an abortion procedure. “They try to delay it as much as possible to gain weeks, which is one of their methods to make the patient change their minds,” because more time has passed, and she no longer wants to undergo the procedure, she explained.

Also, these pseudo-clinics offer free services, which many seek in desperation. They use the technique of making patients “see something they don’t want to see,” like a sonogram, a doll in the shape of a fetus, or baby gifts, something Vale Moreno described as cruel because it seeks to convince at all costs what they promote, regardless of the patient.

The most concerning issue is that they put patients at risk, as receiving care at a place without medical credentials could overlook complications like ectopic pregnancies or fetal problems, explained the gynecologist.

Vale Moreno, who in the past has been threatened by anti-abortion groups and has had to work wearing a bulletproof vest, is concerned that the interventions of these anti-abortion centers may lead pregnant people, especially the youngest, to resort to illegal means to obtain abortion pills, exposing them to additional health and safety risks.

She also fears that minors may go to these pseudo-clinics seeking actual counseling and be forced to give birth, without any protocol being activated in the event of a possible rape or incest case, a protocol that is activated in actual abortion clinics for any minor. Since they are unregulated, they do not follow any Department of Health rules, something that abortion clinics, like any certified healthcare center, must comply with.

They Deny Being a “Pregnancy Center,” But Their
Corporate Registration Contradicts Them

The director of Centro Raquel, Lilibeth Febres, told the Unidad Investigativa de Género that they began operations “at the end of 2016.” However, it is registered as a nonprofit entity offering religious services with the Department of State since 2012 under the name “Casa Raquel.” Although Febres maintained that “at no time here do we say this is a pregnancy center” because they also offer help to survivors of domestic violence and do not offer information with religious bias, their corporate registration states that their objective is to “educate, counsel, raise awareness, and provide personalized Christian, moral, medical, and psychosocial support to educate couples, women, and men so that abortion is not the chosen alternative for an unwanted pregnancy.”

Casa Raquel serves approximately five people a day and started as an initiative of the Santa Bernardita Parish but operates with a board of directors as “a private agency, and we are not accountable to anyone,” said Febres. The only two employees of the center are Febres, who said she was “an evaluator and health services investigator” at the Department of Health, and a counselor who “is a community services psychologist.” According to Febres, the rest of the people are “volunteers,” including a retired obstetrician-gynecologist and a former judge, who offer medical and legal counseling, respectively, but Febres declined to identify them.

One of the services that Centro Raquel advertises is “abortion reversal treatment,” something that, according to the American College of Obstetricians and Gynecologists, is not based on science and does not meet clinical standards.

Febres indicated that Centro Raquel is sustained by donations and does not receive state or federal funds. Still, it does receive professionals from the Department of Health for prenatal, breastfeeding, and parenting guidance. Additionally, adoption counseling is offered “in coordination with the Department of the Family,” and someone from the Agricultural Extension Service provides nutritional information.

When someone arrives at Centro Raquel and asks about abortion, Febres said, “They are counseled about all the consequences it can have,” among which she highlighted “post-abortion symptoms,” such as “depression, anxiety, and you can even have sepsis physically, hemorrhages, etc.” When asked where she got this information, she said it was “scientific,” though she did not provide the “scientific studies” she referred to.

Febres said they follow a protocol for attending to women called the Love Proposal, from Heartbeat International, described on its website as an international anti-abortion association that supports the world’s largest network of crisis pregnancy centers, with more than 3,000 affiliates around the world. They do not offer, recommend, or refer for abortions. It is the largest anti-abortion network in the United States, which was questioned in 2022 by a group of Democratic senators led by Elizabeth Warren, who asked the entity to disclose how it collects, protects, and shares the information of pregnant people, as they were concerned that this could be used as an anti-abortion judicial prosecution against them. This year, the U.S. House of Representatives requested an investigation into the government funds received by Heartbeat International and other anti-abortion entities for their anti-medical and unethical practices, reported The Hill.

Although Febres said they follow the HIPAA Law to protect people’s information, ACOG warns that these centers, not having certified medical personnel or being regulated by the government, “are not subject to privacy laws, like HIPAA.”  Abortion, Every Day reported that Heartbeat International might be “recklessly” sharing private health data from women from all of the anti-abortion centers in its network with corporate employees and others.

Febres denied having an ultrasound machine and said they refer women to a certified place to get a sonogram. However, in an interview with VitaminaER, a YouTube page on “everyday health topics,” Febres said: “We have the [ultrasound] machine here, but we need personnel who can operate it… we are looking for sonographers, especially if they are volunteers.”

Regarding the possibility of a pregnant minor arriving, she was asked if a rape protocol would be activated, as happens in clinics that perform abortions. “The protocol in that case is that they come with an adult,” and “then we guide them with that adult,” Febres simply stated. This protocol could be counterproductive, said Dr. Vale Moreno, as many minors are afraid to speak about what happened in front of an adult, especially if that adult could be responsible for the rape or incest.

A Model Imported from the United States

In the United States, there are at least 4,000 crisis pregnancy centers. For every abortion clinic, there are three of these pseudo-clinics, according to a study on these centers that covered nine states and that was conducted by Alliance State Advocates. They use manipulation tactics such as instilling fear with “post-abortion syndrome,” a nonexistent mental illness, as it is not recognized by the American Psychological Association or the American Psychiatric Association.

These anti-abortion centers raised at least $1.4 billion in the fiscal year 2022, when Roe v. Wade was overturned. According to The Guardian, this figure includes more than $344 million in public funds.

For this reason, earlier this year, President Joe Biden’s administration attempted to ban these centers from using funds from the Temporary Assistance for Needy Families (TANF) program, because they do not meet the purpose of preventing pregnancies. However, Republicans in Congress blocked the proposal.

In an attempt to prevent these centers from spreading false or misleading information about abortion, Illinois is one of the few states that passed a law to sanction and investigate these practices as a form of fraud.

María: “Hope (Women’s Clinic) Was What Traumatized Me the Most”

When the day of her abortion appointment at Darlington Medical Associates arrived, María went with her boyfriend. When she realized that there was a Hope Women’s Clinic just steps from the abortion clinic, María shuddered. “I got goosebumps”. That’s when I said: ‘Damn, these people have an agenda.’ Their only goal is to attract vulnerable people, take advantage of their vulnerability, and convince them at all costs to make a decision that they (the pregnant people) don’t want to make,” she said.

Since the pregnancy was far along, María could no longer use the abortion pill and had to resort to a surgical abortion. At the time María mistakenly arrived at Hope Women’s Clinic, she was still within the timeframe to have a medication abortion, a simpler and less expensive procedure.

The nurse at Darlington Medical Associates held her hand throughout the procedure, and the next day, María returned to work, without pain or regrets. She said she felt like a weight had been lifted off her shoulders.

“They [Hope Women’s Clinic] tell you that abortion causes trauma, but I think what traumatized me the most was not the termination process, but visiting them and the way they try to play with your beliefs and emotions to force you to make a decision you don’t want to make,” said María, who shared her experience so that others don’t go through the same thing.

Despite receiving more calls from Hope Women’s Clinic to ask about her decision, María was evasive. “The process became more complicated because I waited,” she acknowledged. “That decision is mine alone, and they [Hope] didn’t respect that in any way.”

If you need an abortion, one of these four regulated clinics could help you: Darlington Medical Associates and Clínica IELLA in San Juan, Clínica de Planificación Familiar in Bayamón, and Women’s Medical Pavilion in Carolina.

This report is made possible partly through the Zarelia-Poder Elegir Grant, promoted by Fundación El Churo, Festival Zarelia, Wambra Medio Comunitario, with the support of Poder Elegir Project by Oxfam Latin America and Global Affairs Canada.